# FRUITVALE LONG TERM CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fruitvale Health Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508295478
- **Authorized official:** KAM MCGAVOCK (PRESIDENT)
- **Authorized official phone:** (410) 773-1000

## Contact information

- **Practice address:** 3020 E 15TH ST, OAKLAND, CA 94601-2305
- **Practice address phone:** (510) 261-5613
- **Mailing address:** 920 RIDGEBROOK RD, SPARKS, MD 21152-9390

## Taxonomy

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

## Other

- **Enumeration date:** 11/01/2013
- **Last updated:** 11/01/2013