Healthcare Provider Details

I. General information

NPI: 1497179634
Provider Name (Legal Business Name): TRIPLE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 HEADWATER DR
VALLEJO CA
94591-6343
US

IV. Provider business mailing address

3549 HEADWATER DR
VALLEJO CA
94591-6343
US

V. Phone/Fax

Practice location:
  • Phone: 707-334-7264
  • Fax: 888-624-7535
Mailing address:
  • Phone: 707-334-7264
  • Fax: 888-624-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA65412
License Number StateCA

VIII. Authorized Official

Name: HUAMING CHOU
Title or Position: OWNER
Credential: MD
Phone: 707-334-7264