Organization
THE WATERS EDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNN MUSERELLI (HEALTH INFORMATION MANAGER)
(510) 522-1084
Entity
Organization
Contact information
Practice address
2401 BLANDING AVE, ALAMEDA, CA 94501-1503
(510) 522-1084
(510) 748-4289
Mailing address
2401 BLANDING AVE, ALAMEDA, CA 94501-1503
(510) 522-1084
(510) 748-4289
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR18267G
—
CA
Enumeration date
10/03/2005
Last updated
08/22/2020
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