Provider Demographics
NPI:1740401074
Name:HEBREW HOME FOR AGED DISABLED DBA JEWISH HOME
Entity Type:Organization
Organization Name:HEBREW HOME FOR AGED DISABLED DBA JEWISH HOME
Other - Org Name:JEWISH HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-469-2258
Mailing Address - Street 1:302 SILVER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1510
Mailing Address - Country:US
Mailing Address - Phone:415-469-2262
Mailing Address - Fax:
Practice Address - Street 1:302 SILVER AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1510
Practice Address - Country:US
Practice Address - Phone:415-469-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000224282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054089Medicare Oscar/Certification