Provider Demographics
NPI:1538356795
Name:CASTRO VALLEY HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:CASTRO VALLEY HEALTH CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:
Authorized Official - Last Name:PODDATOORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-352-3402
Mailing Address - Street 1:524 CALLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4610
Mailing Address - Country:US
Mailing Address - Phone:510-352-3402
Mailing Address - Fax:510-352-8530
Practice Address - Street 1:20259 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5307
Practice Address - Country:US
Practice Address - Phone:510-352-3402
Practice Address - Fax:510-352-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFEDERAL ID NUMBER