Provider Demographics
NPI:1114097557
Name:COVIA COMMUNITIES
Entity Type:Organization
Organization Name:COVIA COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-953-7446
Mailing Address - Street 1:2185 N CALIFORNIA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3566
Mailing Address - Country:US
Mailing Address - Phone:925-956-7400
Mailing Address - Fax:925-407-0060
Practice Address - Street 1:5555 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-8846
Practice Address - Country:US
Practice Address - Phone:707-538-8400
Practice Address - Fax:707-579-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490107656314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555268Medicare Oscar/Certification