Provider Demographics
NPI:1790850329
Name:SAN LEANDRO HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:SAN LEANDRO HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:PODDATOORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-386-3340
Mailing Address - Street 1:524 CALLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-0000
Mailing Address - Country:US
Mailing Address - Phone:510-352-3402
Mailing Address - Fax:510-352-8530
Practice Address - Street 1:368 JUANA AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-0000
Practice Address - Country:US
Practice Address - Phone:510-357-4015
Practice Address - Fax:510-357-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02 0000097314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056345Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA056345Medicare Oscar/Certification