Provider Demographics
NPI:1730275769
Name:TRINITY OAKLAND, INC
Entity type:Organization
Organization Name:TRINITY OAKLAND, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-820-9750
Mailing Address - Street 1:8487 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3222
Mailing Address - Country:US
Mailing Address - Phone:951-688-2222
Mailing Address - Fax:951-688-7659
Practice Address - Street 1:8487 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3222
Practice Address - Country:US
Practice Address - Phone:951-688-2222
Practice Address - Fax:951-688-7659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY OAKLAND, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000241314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05542JMedicaid
CA055542Medicare ID - Type Unspecified