Provider Demographics
NPI:1376515817
Name:FMSC SAN RAFAEL OPERATING COMPANY LP
Entity Type:Organization
Organization Name:FMSC SAN RAFAEL OPERATING COMPANY LP
Other - Org Name:PINERIDGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL FINANCIAL ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-208-1940
Mailing Address - Street 1:45 PROFESSIONAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2702
Mailing Address - Country:US
Mailing Address - Phone:415-479-3610
Mailing Address - Fax:
Practice Address - Street 1:45 PROFESSIONAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2702
Practice Address - Country:US
Practice Address - Phone:415-479-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05850MMedicaid
CAZZR05850MMedicaid
CA05-5850Medicare PIN
CA055850Medicare Oscar/Certification