Provider Demographics
NPI:1629242599
Name:NAPA SKILLED NURSING CENTER
Entity Type:Organization
Organization Name:NAPA SKILLED NURSING CENTER
Other - Org Name:NAZARETH SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HANHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-347-9500
Mailing Address - Street 1:800 S B ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4272
Mailing Address - Country:US
Mailing Address - Phone:650-347-9500
Mailing Address - Fax:650-347-9400
Practice Address - Street 1:2465 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3103
Practice Address - Country:US
Practice Address - Phone:707-255-3012
Practice Address - Fax:707-255-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05549KMedicaid
CA055549Medicare UPIN