MEDICARE: MCCLURE CONVALESCENT HOSPITAL AND REHABILITATION CENTER, 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	332BN1400X	Nursing Facility Supplies (DME)	020000064	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	020000064	CA
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	020000064	CA
4	314000000X	Skilled Nursing Facility	020000064	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	:	1922090091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCLURE CONVALESCENT HOSPITAL AND REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	5000 EXECUTIVE PKWY
Second Line	:	SUITE 150
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4210
Country	:	US
Telephone Number	:	925-855-0881
Fax Number	:	925-855-9297

Provider Business Practice Location Address
First Line	:	2910 MCCLURE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-3505
Country	:	US
Telephone Number	:	510-836-3677
Fax Number	:	510-836-1938

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES PREIMESBERGER
Credential	:
Telephone Number	:	925-855-0881

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/13/2014

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