=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033508569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHAWAR CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2015
-----------------------------------------------------
Last Update Date | 01/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 MOWRY AVE STE 101
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-212-7375
-----------------------------------------------------
Fax | 925-969-1608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 993 OAK GROVE RD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-212-7375
-----------------------------------------------------
Fax | 925-969-1608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. RASHMIKA MAHAWAR
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 925-212-7375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 079200369
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------