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General NPI Number Information
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NPI Number | 1538356795
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Entity Type | Organization
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Legal Business Name | CASTRO VALLEY HEALTH CARE CENTER, INC.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 20259 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5307
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Country | US
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Telephone | 510-352-3402
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Fax | 510-352-8530
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Provider Business Mailing Address
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Address Line | 524 CALLAN AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4610
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Country | US
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Telephone | 510-352-3402
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Fax | 510-352-8530
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. PRATAP PODDATOORI
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Credential |
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Telephone | 510-352-3402
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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 |
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License Number State |
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