Provider Demographics
NPI:1568238848
Name:REDWOOD ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:REDWOOD ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ALIN
Authorized Official - Last Name:TET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-797-9266
Mailing Address - Street 1:18821 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2907
Mailing Address - Country:US
Mailing Address - Phone:415-797-9266
Mailing Address - Fax:
Practice Address - Street 1:18785 CARLTON AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2905
Practice Address - Country:US
Practice Address - Phone:510-292-8610
Practice Address - Fax:510-315-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility