# CLINTON VILLAGE CONVALESCENT HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Protean healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154478360
- **Authorized official:** FERMER LUKBAN (MANAGER)
- **Authorized official phone:** (510) 536-6512

## Contact information

- **Practice address:** 1833 10TH AVE, OAKLAND, CA 94606-3023
- **Practice address phone:** (510) 536-6512
- **Practice address fax:** (510) 536-1450
- **Mailing address:** 1833 10TH AVE, OAKLAND, CA 94606-3023
- **Mailing address phone:** (510) 536-6512
- **Mailing address fax:** (510) 536-1450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR06341I | — | CA |