Basic Information
| Provider Information | |||||||||
| NPI: | 1538470828 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAN FRANCISCO HEALTHCARE & WELLNESS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1477 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155630565 | ||||||||
| FaxNumber: | 2082380460 | ||||||||
| Practice Location | |||||||||
| Address1: | 1477 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155630565 | ||||||||
| FaxNumber: | 2082380460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | MAJER | ||||||||
| AuthorizedOfficialFirstName: | SOL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3236341940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 220000011 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 056272 | 01 | CA | MEDICARE ID-TYPE UNSPECIFIED | OTHER | ZZR06272H | 05 | CA | MEDICAID |