Provider Demographics
NPI:1578675997
Name:BERKELEY PINES CARE CENTER, INC.
Entity Type:Organization
Organization Name:BERKELEY PINES CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-808-6540
Mailing Address - Street 1:1355 WILLOW WAY
Mailing Address - Street 2:SUITE 264
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5723
Mailing Address - Country:US
Mailing Address - Phone:925-808-6544
Mailing Address - Fax:
Practice Address - Street 1:2223 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1907
Practice Address - Country:US
Practice Address - Phone:510-649-6670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A. T. ASSOCIATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47959499314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05892KMedicaid
CA0624890004Medicare NSC
CAZZR05892KMedicaid