Organization
VIROSA, LLC
Active
Other names
Central Valley Congregate Living
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX RUDAKOV (PRESIDENT)
(415) 812-2955
Entity
Organization
Contact information
Practice address
1051 TENNIS LN, TRACY, CA 95376-4417
(415) 812-2955
Mailing address
1051 TENNIS LN, TRACY, CA 95376-4417
(415) 812-2955
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
550003672
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550003672
LICENSE NUMBER
CA
01
—
630015978
FACILITY ID
CA
Enumeration date
10/06/2016
Last updated
10/06/2016
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