Provider Demographics
NPI:1639178429
Name:AQUINAS CORPORATION
Entity Type:Organization
Organization Name:AQUINAS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:408-248-7100
Mailing Address - Street 1:3580 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2925
Mailing Address - Country:US
Mailing Address - Phone:408-248-7100
Mailing Address - Fax:408-248-1856
Practice Address - Street 1:3580 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-2925
Practice Address - Country:US
Practice Address - Phone:408-248-7100
Practice Address - Fax:408-248-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-04-01
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
CAZZR05884JMedicaid
CAZZR05884JMedicaid
CA055884Medicare ID - Type Unspecified