Provider Demographics
NPI:1942200225
Name:ODD FELLOWS HOME OF CALIFORNIA
Entity Type:Organization
Organization Name:ODD FELLOWS HOME OF CALIFORNIA
Other - Org Name:SARATOGA RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-857-7215
Mailing Address - Street 1:14500 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6165
Mailing Address - Country:US
Mailing Address - Phone:408-741-7000
Mailing Address - Fax:408-741-7157
Practice Address - Street 1:14500 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6165
Practice Address - Country:US
Practice Address - Phone:408-741-7000
Practice Address - Fax:408-741-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000416314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06481FMedicaid
CAZZR06481FMedicaid