Provider Demographics
NPI:1093156952
Name:GARDENIA SENIOR CARE CENTER INC
Entity Type:Organization
Organization Name:GARDENIA SENIOR CARE CENTER INC
Other - Org Name:LOTUS RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:NOORJAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-604-0348
Mailing Address - Street 1:19317 SANTA MARIA AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3402
Mailing Address - Country:US
Mailing Address - Phone:510-604-0348
Mailing Address - Fax:510-763-7367
Practice Address - Street 1:19317 SANTA MARIA AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-3402
Practice Address - Country:US
Practice Address - Phone:510-604-0348
Practice Address - Fax:510-763-7367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015601426310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility