Provider Demographics
NPI:1063640597
Name:UNITED FAMILY MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:UNITED FAMILY MEDICAL SUPPLY, INC.
Other - Org Name:WISTERIA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:ULEP
Authorized Official - Last Name:TABURAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-673-1785
Mailing Address - Street 1:2836 E COGHILL TER
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1189
Mailing Address - Country:US
Mailing Address - Phone:510-673-1785
Mailing Address - Fax:925-828-2088
Practice Address - Street 1:20524 WISTERIA ST
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5523
Practice Address - Country:US
Practice Address - Phone:510-727-9169
Practice Address - Fax:510-727-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555761Medicare Oscar/Certification