Healthcare Provider Details

I. General information

NPI: 1063341444
Provider Name (Legal Business Name): TICE VALLEY RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 TICE VALLEY BLVD
WALNUT CREEK CA
94595-2616
US

IV. Provider business mailing address

2206 TICE VALLEY BLVD
WALNUT CREEK CA
94595-2616
US

V. Phone/Fax

Practice location:
  • Phone: 925-705-7841
  • Fax:
Mailing address:
  • Phone: 925-705-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK S GUTIERREZ
Title or Position: MANAGER
Credential:
Phone: 650-580-7748