Provider Demographics
NPI:1093872715
Name:CENTRAL GARDENS, INC.
Entity Type:Organization
Organization Name:CENTRAL GARDENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-567-2967
Mailing Address - Street 1:1355 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4215
Mailing Address - Country:US
Mailing Address - Phone:415-567-2967
Mailing Address - Fax:415-567-5933
Practice Address - Street 1:1355 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4215
Practice Address - Country:US
Practice Address - Phone:415-567-2967
Practice Address - Fax:415-567-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
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
CAZZR05280FMedicaid
CAZZR05280FMedicaid