Organization
FRUITVALE LONG TERM CARE LLC
Active
Other names
Fruitvale Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
KAM MCGAVOCK (PRESIDENT)
(410) 773-1000
Entity
Organization
Contact information
Practice address
3020 E 15TH ST, OAKLAND, CA 94601-2305
(510) 261-5613
Mailing address
920 RIDGEBROOK RD, SPARKS, MD 21152-9390
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/01/2013
Last updated
11/01/2013
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