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General NPI Number Information
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NPI Number | 1699720862
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Entity Type | Organization
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Legal Business Name | BAYWOOD COURT SKILLED NURSING FACILITY
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 20103 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5341
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Country | US
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Telephone | 510-727-8290
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Fax | 510-582-1730
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Provider Business Mailing Address
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Address Line | 3012 SUMMIT ST
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City | OAKLAND
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State | CA
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Zip | 94609-3480
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Country | US
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Telephone | 510-869-6591
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Fax | 510-869-6592
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Authorized Official
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Title or Position | REGIONAL DIRECTOR - PFS
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Name | MR. GEORGE DERBEDROSIAN
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Credential |
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Telephone | 510-869-6163
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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 | 140000030
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License Number State | CA
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