Provider Demographics
NPI:1053309401
Name:RCC FACILITY INC.
Entity Type:Organization
Organization Name:RCC FACILITY INC.
Other - Org Name:ROUNSEVILLE REHAB. CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:510-658-2041
Mailing Address - Street 1:210 40TH STREET WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5612
Mailing Address - Country:US
Mailing Address - Phone:510-658-2041
Mailing Address - Fax:510-658-3108
Practice Address - Street 1:210 40TH STREET WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5612
Practice Address - Country:US
Practice Address - Phone:510-658-2041
Practice Address - Fax:510-658-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555313Medicare ID - Type Unspecified