Provider Demographics
NPI:1407924582
Name:NORCAL CARE CENTERS, INC
Entity Type:Organization
Organization Name:NORCAL CARE CENTERS, INC
Other - Org Name:ANTIOCH CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-757-8787
Mailing Address - Street 1:1210 A ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2327
Mailing Address - Country:US
Mailing Address - Phone:925-757-8787
Mailing Address - Fax:925-727-2314
Practice Address - Street 1:1210 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2327
Practice Address - Country:US
Practice Address - Phone:925-757-8787
Practice Address - Fax:925-727-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000069314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06381JMedicaid
CA056381Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER