Provider Demographics
NPI:1891272803
Name:MORAGA RETREAT CARE HOME INCORPORATED
Entity Type:Organization
Organization Name:MORAGA RETREAT CARE HOME INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:BLAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-708-9877
Mailing Address - Street 1:715 MORAGA RD
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2341
Mailing Address - Country:US
Mailing Address - Phone:925-376-2273
Mailing Address - Fax:925-376-7137
Practice Address - Street 1:715 MORAGA RD
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2341
Practice Address - Country:US
Practice Address - Phone:925-376-2273
Practice Address - Fax:925-376-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075601205310400000X
CA075601509310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility