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General NPI Number Information
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NPI Number | 1942200225
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Entity Type | Organization
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Legal Business Name | ODD FELLOWS HOME OF CALIFORNIA
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 14500 FRUITVALE AVE
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City | SARATOGA
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State | CA
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Zip | 95070-6165
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Country | US
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Telephone | 408-741-7000
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Fax | 408-741-7157
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Provider Business Mailing Address
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Address Line | 14500 FRUITVALE AVE
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City | SARATOGA
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State | CA
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Zip | 95070-6165
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Country | US
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Telephone | 408-741-7000
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Fax | 408-741-7157
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Authorized Official
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Title or Position | COO
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Name | ANTHONY SABATINI
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Credential |
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Telephone | 971-221-1425
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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 | 220000416
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License Number State | CA
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