Basic Information
| Provider Information | |||||||||
| NPI: | 1821163767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW COVENANT CARE OF CALIFORNIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 TAMPICO | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259337970 | ||||||||
| FaxNumber: | 9252561676 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 TAMPICO | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259337970 | ||||||||
| FaxNumber: | 9252561676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | KREH | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE (LARRY) | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9259377400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 140000138 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR06213H | 05 | CA | MEDICAID |