# COVENANT CARE CALIFORNIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Tree Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346382298
- **Authorized official:** CAROL SPARKS (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (949) 349-1200

## Contact information

- **Practice address:** 2124 57TH AVENUE, OAKLAND, CA 94621-4322
- **Practice address phone:** (510) 261-2628
- **Practice address fax:** (510) 261-5483
- **Mailing address:** 2124 57TH AVENUE, OAKLAND, CA 94621-4322
- **Mailing address phone:** (510) 261-2628
- **Mailing address fax:** (510) 261-5483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 020000123 | CA | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 02/03/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 206010995 | OSHPD | CA |
| 05 | — | ZZR05876I | — | CA |