Provider Demographics
NPI:1689063489
Name:ST ANTHONY SERENETHOS SNF,LLC
Entity Type:Organization
Organization Name:ST ANTHONY SERENETHOS SNF,LLC
Other - Org Name:ST ANTHONY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:XIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:151-073-3387
Mailing Address - Street 1:553 SMALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4919
Mailing Address - Country:US
Mailing Address - Phone:510-733-3877
Mailing Address - Fax:510-446-8631
Practice Address - Street 1:553 SMALLEY AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4919
Practice Address - Country:US
Practice Address - Phone:510-733-3877
Practice Address - Fax:510-446-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346239928OtherNPI
CA1689063489Medicaid
CAZZR05809IMedicaid