Organization
CLINTON VILLAGE CONVALESCENT HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE D. PARKER (ACCOUNT EXECUTIVE)
(510) 537-7088
Entity
Organization
Contact information
Practice address
1833 10TH AVE, OAKLAND, CA 94606-3023
(510) 536-6510
(510) 536-4319
Mailing address
1833 10TH AVE, OAKLAND, CA 94606-3023
(510) 536-6510
(510) 536-4319
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
LTC90086F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC90086F
—
CA
Enumeration date
12/28/2007
Last updated
12/28/2007
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