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General NPI Number Information
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NPI Number | 1275670895
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Entity Type | Organization
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Legal Business Name | SSC OAKLAND FRUITVALE OPERATING COMPANY LP
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 3020 E 15TH ST
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City | OAKLAND
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State | CA
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Zip | 94601-2305
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Country | US
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Telephone | 510-261-5613
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Fax | 510-261-5940
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Provider Business Mailing Address
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Address Line | 5300 W SAM HOUSTON PKWY N SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77041-5161
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Country | US
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Telephone | 832-467-6000
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR AR
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Name | KELLE C SANTORO
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Credential |
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Telephone | 832-467-5728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 020000067
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License Number State | CA
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