Basic Information
| Provider Information | |||||||||
| NPI: | 1891964003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFEHOUSE CASTRO VALLEY OPERATIONS, LLC | ||||||||
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| OtherOrganizationName: | CASTRO VALLEY HEALTHCARE & REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 NORTH REAL ROAD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613277107 | ||||||||
| FaxNumber: | 6613273147 | ||||||||
| Practice Location | |||||||||
| Address1: | 20259 LAKE CHABOT RD | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945465307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103513700 | ||||||||
| FaxNumber: | 5103823722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | ANDRIOTTI | ||||||||
| AuthorizedOfficialFirstName: | LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3103371929 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIFEHOUSE HEALTH SERVICES, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 020000018 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.