Provider Demographics
NPI:1083606115
Name:INDEPENDENT QUALITY CARE
Entity Type:Organization
Organization Name:INDEPENDENT QUALITY CARE
Other - Org Name:COURTYARD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-855-0881
Mailing Address - Street 1:3 CROW CANYON CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1966
Mailing Address - Country:US
Mailing Address - Phone:925-855-0881
Mailing Address - Fax:925-855-9297
Practice Address - Street 1:1625 DENTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1943
Practice Address - Country:US
Practice Address - Phone:510-782-2133
Practice Address - Fax:516-783-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
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
CAZZR05999GMedicaid
CA055999Medicare ID - Type Unspecified