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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