=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194895631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVIA COMMUNITIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WOOD RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95030-6704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-354-0211
-----------------------------------------------------
Fax | 408-354-4193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2185 N CALIFORNIA BLVD STE 215
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-3566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-956-7400
-----------------------------------------------------
Fax | 925-407-0060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE/CORPORATE CONTROLLER
-----------------------------------------------------
Name | MITZI HYLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-956-7410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 070000062
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------