Provider Demographics
NPI:1417217571
Name:BAY AREA JEWISH SENIOR LIFE
Entity Type:Organization
Organization Name:BAY AREA JEWISH SENIOR LIFE
Other - Org Name:STARS BURLINGAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-562-2680
Mailing Address - Street 1:302 SILVER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1510
Mailing Address - Country:US
Mailing Address - Phone:415-562-2680
Mailing Address - Fax:
Practice Address - Street 1:1609 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4520
Practice Address - Country:US
Practice Address - Phone:415-562-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility