Provider Demographics
NPI:1598148983
Name:MILLBRAE SKILLED CARE LLC
Entity Type:Organization
Organization Name:MILLBRAE SKILLED CARE LLC
Other - Org Name:MILLBRAE SKILLED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PREIMESBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-855-0881
Mailing Address - Street 1:5615 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3625
Mailing Address - Country:US
Mailing Address - Phone:408-226-0300
Mailing Address - Fax:408-226-3800
Practice Address - Street 1:5000 EXECUTIVE PKWY
Practice Address - Street 2:STE 150
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4210
Practice Address - Country:US
Practice Address - Phone:925-855-0881
Practice Address - Fax:925-855-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility