Provider Demographics
NPI:1144856535
Name:FRUITVALE OPERATING COMPANY, LP
Entity type:Organization
Organization Name:FRUITVALE OPERATING COMPANY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-804-8111
Mailing Address - Street 1:3060 MERCER UNIVERSITY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4135
Mailing Address - Country:US
Mailing Address - Phone:678-443-6772
Mailing Address - Fax:
Practice Address - Street 1:3020 E 15TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2305
Practice Address - Country:US
Practice Address - Phone:510-261-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility