Provider Demographics
NPI:1912192261
Name:LIFEHOUSE SAN JOSE OPERATIONS, LLC
Entity Type:Organization
Organization Name:LIFEHOUSE SAN JOSE OPERATIONS, LLC
Other - Org Name:SAN JOSE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-337-1929
Mailing Address - Street 1:329 NORTH REAL ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1820
Mailing Address - Country:US
Mailing Address - Phone:661-327-7107
Mailing Address - Fax:661-327-1152
Practice Address - Street 1:180 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1907
Practice Address - Country:US
Practice Address - Phone:408-259-8700
Practice Address - Fax:408-259-2343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING DHS APPROVAL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056082Medicare Oscar/Certification