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NPI Code Detail

MEDICARE: MILLBRAE CARE CENTER LLC

MEDICARE: MILLBRAE CARE CENTER LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1609429638
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILLBRAE CARE CENTER LLC
Provider Business Mailing Address
First Line : 13347 VENTURA BLVD
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91423-4267
Country : US
Telephone Number : 818-385-3200
Fax Number : 818-385-3287
Provider Business Practice Location Address
First Line : 33 MATEO AVE
Second Line :
City : MILLBRAE
State : CA
Zip : 94030-2037
Country : US
Telephone Number : 650-689-5784
Fax Number : 650-689-5946
Authorized Official
Title or Position : MANAGER
Name : MR. RONALD MAYER
Credential :
Telephone Number : 818-385-3200
Provider Enumeration Date : 07/18/2019
Last Update Date : 07/18/2019

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Directions to “MILLBRAE CARE CENTER LLC ” Practice Location

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