Provider Demographics
NPI:1225220676
Name:CENTRAL BAY HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:CENTRAL BAY HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE OPERATION MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAUTIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-834-4100
Mailing Address - Street 1:400 29TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3522
Mailing Address - Country:US
Mailing Address - Phone:510-834-4100
Mailing Address - Fax:510-834-4757
Practice Address - Street 1:400 29TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3522
Practice Address - Country:US
Practice Address - Phone:510-834-4100
Practice Address - Fax:510-834-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACH 100-883052332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6038920001Medicare NSC