MEDICARE: 3230 CARLSON BLVD 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1932067584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3230 CARLSON BLVD LLC

Provider Business Mailing Address
First Line	:	2305 HISTORIC DECATUR RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 CARLSON BLVD
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3907
Country	:	US
Telephone Number	:	510-525-3212
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RICHARD MARTIN
Credential	:
Telephone Number	:	510-525-3212

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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