Provider Demographics
NPI:1902127392
Name:J3TFZ, INC.
Entity Type:Organization
Organization Name:J3TFZ, INC.
Other - Org Name:TAMPICO TERRACE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-949-3189
Mailing Address - Street 1:130 TAMPICO
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2948
Mailing Address - Country:US
Mailing Address - Phone:925-933-7970
Mailing Address - Fax:925-256-1676
Practice Address - Street 1:130 TAMPICO
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2948
Practice Address - Country:US
Practice Address - Phone:925-933-7970
Practice Address - Fax:925-256-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056213OtherMEDICARE PTAN
CA056213OtherMEDICARE PTAN