Provider Demographics
NPI:1497738363
Name:ALDERSLY, INC
Entity Type:Organization
Organization Name:ALDERSLY, INC
Other - Org Name:ALDERSLY SKILLED NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-851-4000
Mailing Address - Street 1:326 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3498
Mailing Address - Country:US
Mailing Address - Phone:415-453-7425
Mailing Address - Fax:415-453-6377
Practice Address - Street 1:326 MISSION AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3425
Practice Address - Country:US
Practice Address - Phone:415-453-7425
Practice Address - Fax:415-453-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC90075FMedicaid
CALTC90075FMedicaid