Provider Demographics
NPI:1114119054
Name:G & R ALAMEDA HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:G & R ALAMEDA HEALTHCARE SERVICES, LLC
Other - Org Name:CROWN BAY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGONCILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-304-6900
Mailing Address - Street 1:445 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2632
Mailing Address - Country:US
Mailing Address - Phone:626-304-6900
Mailing Address - Fax:626-564-2617
Practice Address - Street 1:508 WESTLINE DR
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5847
Practice Address - Country:US
Practice Address - Phone:510-521-5765
Practice Address - Fax:510-521-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06103HMedicaid
CA056103Medicare Oscar/Certification