=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538593447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAFFAR ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2013
-----------------------------------------------------
Last Update Date | 08/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 3RD AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94606-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-834-9880
-----------------------------------------------------
Fax | 510-763-7367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19317 SANTA MARIA AVE
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94546-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-834-9880
-----------------------------------------------------
Fax | 510-763-7367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GAFFAR SYED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-834-9880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 015601408
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------