Provider Demographics
NPI:1245989805
Name:GIMAG TRANSITIONAL CARE
Entity type:Organization
Organization Name:GIMAG TRANSITIONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUSAYO
Authorized Official - Middle Name:P
Authorized Official - Last Name:EKUNBOYEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-435-4946
Mailing Address - Street 1:704 W REDLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1203
Mailing Address - Country:US
Mailing Address - Phone:510-435-4946
Mailing Address - Fax:
Practice Address - Street 1:1280 MANLEY DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8808
Practice Address - Country:US
Practice Address - Phone:510-435-4946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000000OtherPRIVATE INSURANCE, WORKERS COMPENSATION AND PRIVATE