MEDICARE: VINTAGE ESTATES III INC

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

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	:	1821087966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINTAGE ESTATES III INC

Provider Business Mailing Address
First Line	:	25919 GADING RD
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-2725
Country	:	US
Telephone Number	:	510-782-3825
Fax Number	:	510-782-8793

Provider Business Practice Location Address
First Line	:	955 23RD ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1250
Country	:	US
Telephone Number	:	510-237-5182
Fax Number	:	510-237-5152

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SALLY JANE RAPP
Credential	:
Telephone Number	:	510-782-3825

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/13/2010

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