Healthcare Provider Details

I. General information

NPI: 1942200225
Provider Name (Legal Business Name): ODD FELLOWS HOME OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 FRUITVALE AVE
SARATOGA CA
95070-6165
US

IV. Provider business mailing address

14500 FRUITVALE AVE
SARATOGA CA
95070-6165
US

V. Phone/Fax

Practice location:
  • Phone: 408-741-7000
  • Fax: 408-741-7157
Mailing address:
  • Phone: 408-741-7000
  • Fax: 408-741-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000416
License Number StateCA

VIII. Authorized Official

Name: SARAH STEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-504-3916