Provider Demographics
NPI:1225029366
Name:MERCY RETIREMENT AND CARE CENTER
Entity Type:Organization
Organization Name:MERCY RETIREMENT AND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-769-2700
Mailing Address - Street 1:3431 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3129
Mailing Address - Country:US
Mailing Address - Phone:510-534-8540
Mailing Address - Fax:510-261-4516
Practice Address - Street 1:3431 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3129
Practice Address - Country:US
Practice Address - Phone:510-534-8540
Practice Address - Fax:510-261-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020000237314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55189FMedicaid
CALTC55189FMedicaid