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General NPI Number Information
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NPI Number | 1003283722
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Entity Type | Organization
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Legal Business Name | CHENEY HOME ICF-DD/N
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 1644 CHENEY LN
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City | HAYWARD
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State | CA
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Zip | 94545-4331
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Country | US
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Telephone | 510-670-0239
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Fax | 510-784-0294
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Provider Business Mailing Address
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Address Line | 1755 CANTERBURY LN
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City | HAYWARD
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State | CA
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Zip | 94544-8710
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Country | US
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Telephone | 510-861-2635
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Fax | 510-784-0294
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Authorized Official
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Title or Position | RN/ADMINISTRATOR
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Name | MRS. RITA IRENE REGINALDO-ROXAS
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Credential |
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Telephone | 510-861-2635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 550001210
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License Number State | CA
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