Healthcare Provider Details

I. General information

NPI: 1841237112
Provider Name (Legal Business Name): ACACIA CREEK - UNION CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

IV. Provider business mailing address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-3434
  • Fax: 510-471-2402
Mailing address:
  • Phone: 510-471-3434
  • Fax: 510-471-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FALLON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-471-3434