MEDICARE: BAYWOOD COURT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	550000793	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043489016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYWOOD COURT

Provider Business Mailing Address
First Line	:	21966 DOLORES ST
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-6959
Country	:	US
Telephone Number	:	510-733-2102
Fax Number	:	510-733-2480

Provider Business Practice Location Address
First Line	:	21966 DOLORES ST
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-6959
Country	:	US
Telephone Number	:	510-733-2102
Fax Number	:	510-733-2480

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MATT NEAL
Credential	:
Telephone Number	:	510-733-2401

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/24/2023

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Directions to “BAYWOOD COURT ” Practice Location

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