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General NPI Number Information
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NPI Number | 1790850329
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Entity Type | Organization
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Legal Business Name | SAN LEANDRO HEALTH CARE CENTER, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 368 JUANA AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-0000
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Country | US
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Telephone | 510-357-4015
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Fax | 510-357-3466
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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 | 94577-0000
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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 | OWNER
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Name | PAT PODDATOORI
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Credential |
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Telephone | 310-386-3340
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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 | 02 0000097
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License Number State | CA
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