Provider Demographics
NPI:1225103930
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL HOSPICE OAKLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-752-2972
Mailing Address - Street 1:4501 BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4615
Mailing Address - Country:US
Mailing Address - Phone:510-752-6390
Mailing Address - Fax:510-752-7734
Practice Address - Street 1:4501 BROADWAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4615
Practice Address - Country:US
Practice Address - Phone:510-752-6390
Practice Address - Fax:510-752-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000573251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01551FMedicaid
CA051551Medicare Oscar/Certification