Provider Demographics
NPI:1417178138
Name:RIEGER HOME LLC
Entity Type:Organization
Organization Name:RIEGER HOME LLC
Other - Org Name:PARKSIDE HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAESAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-783-2853
Mailing Address - Street 1:1303 RIEGER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4351
Mailing Address - Country:US
Mailing Address - Phone:510-783-2853
Mailing Address - Fax:510-783-3143
Practice Address - Street 1:1303 RIEGER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4351
Practice Address - Country:US
Practice Address - Phone:510-783-2853
Practice Address - Fax:510-783-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80166FMedicare ID - Type UnspecifiedLONG TERM CARE FACILITY