Provider Demographics
NPI:1477875672
Name:CUPERTINO HEALTHCARE & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:CUPERTINO HEALTHCARE & WELLNESS CENTER LLC
Other - Org Name:CUPERTINO HEALTHCARE & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-634-1940
Mailing Address - Street 1:22590 VOSS AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2627
Mailing Address - Country:US
Mailing Address - Phone:408-253-9034
Mailing Address - Fax:408-255-9148
Practice Address - Street 1:22590 VOSS AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2627
Practice Address - Country:US
Practice Address - Phone:408-253-9034
Practice Address - Fax:408-255-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0220000407314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05407HMedicaid
CAZZR05407HMedicaid
CA055407Medicare Oscar/Certification