Basic Information
| Provider Information | |||||||||
| NPI: | 1720505936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WATERFRONT HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CLAYTON RD STE 1220 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105602012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 CLAYTON RD STE 1220 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105602012 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOCHNOUR | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2084011365 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ESQ. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.