Basic Information
| Provider Information | |||||||||
| NPI: | 1093872715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL GARDENS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 ELLIS ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941154215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155672967 | ||||||||
| FaxNumber: | 4155675933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 ELLIS ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941154215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155672967 | ||||||||
| FaxNumber: | 4155675933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEMMON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4155672967 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR05280F | 05 | CA | MEDICAID |