Provider Demographics
NPI:1437512571
Name:FRIENDSHIP CARE HOME
Entity Type:Organization
Organization Name:FRIENDSHIP CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-996-8521
Mailing Address - Street 1:1907 CAVALLO RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2713
Mailing Address - Country:US
Mailing Address - Phone:925-732-7364
Mailing Address - Fax:925-732-7196
Practice Address - Street 1:1907 CAVALLO RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2713
Practice Address - Country:US
Practice Address - Phone:925-732-7364
Practice Address - Fax:925-732-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0792003183104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances