Basic Information
| Provider Information | |||||||||
| NPI: | 1184173056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REDWOOD HEALTHCARE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 W LEMON AVE | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910162809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266587344 | ||||||||
| FaxNumber: | 3238465788 | ||||||||
| Practice Location | |||||||||
| Address1: | 3145 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946191839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105339970 | ||||||||
| FaxNumber: | 5103987264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2016 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | SOLORZANO | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3238369397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 020000045 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.