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Organization
COVENANT CARE CALIFORNIA, LLC
Active
Organization
COVENANT CARE CALIFORNIA, LLC
Active
Other names
Willow Tree Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SPARKS (DIRECTOR OF REIMBURSEMENT)
(949) 349-1200
Entity
Organization
Contact information
Practice address
2124 57TH AVENUE, OAKLAND, CA 94621-4322
(510) 261-2628
(510) 261-5483
Mailing address
2124 57TH AVENUE, OAKLAND, CA 94621-4322
(510) 261-2628
(510) 261-5483
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
020000123
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206010995
OSHPD
CA
05
—
ZZR05876I
—
CA
Enumeration date
02/13/2007
Last updated
02/03/2014
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