Provider Demographics
NPI:1336693654
Name:ON CALL PROVIDER SERVICE
Entity Type:Organization
Organization Name:ON CALL PROVIDER SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARONNE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:510-325-1734
Mailing Address - Street 1:2321 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3907
Mailing Address - Country:US
Mailing Address - Phone:510-325-1734
Mailing Address - Fax:510-562-6493
Practice Address - Street 1:2321 86TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3907
Practice Address - Country:US
Practice Address - Phone:510-325-1734
Practice Address - Fax:510-562-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14579314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003009275OtherNPI