Organization
FAIR OAKS RESIDENTIAL TREATMENT FACILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX RUDAKOV (SECRETARY)
(415) 812-2955
Entity
Organization
Contact information
Practice address
1782 B ST, HAYWARD, CA 94541-3102
(916) 458-4100
Mailing address
2880 ZANKER RD STE 106, SAN JOSE, CA 95134-2121
(415) 812-2955
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2880
—
CA
Enumeration date
01/19/2022
Last updated
01/19/2022
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