Provider Demographics
NPI:1194835017
Name:CHRISTIAN RETIREMENT CENTER OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:CHRISTIAN RETIREMENT CENTER OF NORTHERN CALIFORNIA
Other - Org Name:BETHESDA HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:510-538-8300
Mailing Address - Street 1:22427 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3945
Mailing Address - Country:US
Mailing Address - Phone:510-538-8300
Mailing Address - Fax:510-538-8443
Practice Address - Street 1:22427 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3945
Practice Address - Country:US
Practice Address - Phone:510-538-8300
Practice Address - Fax:510-538-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020000013314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06370FMedicaid
CAZZR06370FMedicaid