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NPI Code Detail

MEDICARE: CLASSIC HEALTHCARE, A SPECIALTY NURSING SERVICE, INC.

MEDICARE: CLASSIC HEALTHCARE, A SPECIALTY NURSING SERVICE, 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
1363L00000XNurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982337473
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLASSIC HEALTHCARE, A SPECIALTY NURSING SERVICE, INC.
Provider Business Mailing Address
First Line : 4475 BRIAR CLIFF RD
Second Line :
City : OAKLAND
State : CA
Zip : 94605-4624
Country : US
Telephone Number : 510-846-8590
Fax Number : 510-638-3400
Provider Business Practice Location Address
First Line : 1300 CLAY ST STE 600
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1427
Country : US
Telephone Number : 510-846-8590
Fax Number : 510-638-3400
Authorized Official
Title or Position : OWNER
Name : DR. WANDA H. JOHNSON
Credential : DNP, FNP-BC, CWOCN
Telephone Number : 510-846-8590
Provider Enumeration Date : 07/02/2022
Last Update Date : 07/02/2022

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