Provider Demographics
NPI:1245212174
Name:WILLIAM A. PRICE
Entity Type:Organization
Organization Name:WILLIAM A. PRICE
Other - Org Name:MISSION BAY CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-647-3587
Mailing Address - Street 1:331 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2950
Mailing Address - Country:US
Mailing Address - Phone:415-647-3587
Mailing Address - Fax:415-647-6885
Practice Address - Street 1:331 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2950
Practice Address - Country:US
Practice Address - Phone:415-647-3587
Practice Address - Fax:415-647-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000113314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05220HMedicaid
CA0422510001Medicare NSC
CA055220Medicare Oscar/Certification