MEDICARE: D'NALOR CARE HOMES, 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
1	310400000X	Assisted Living Facility	019200673	CA

General Provider Information

NPI Number	:	1871037838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D'NALOR CARE HOMES, LLC

Provider Business Mailing Address
First Line	:	2706 106TH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-5210
Country	:	US
Telephone Number	:	510-756-6122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 106TH AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-5210
Country	:	US
Telephone Number	:	510-756-6122
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROLAND WILSON
Credential	:
Telephone Number	:	510-334-5042

Provider Enumeration Date	:	12/10/2016
Last Update Date	:	12/10/2016

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