Provider Demographics
NPI:1942620083
Name:CREEKVIEW HC LLC
Entity Type:Organization
Organization Name:CREEKVIEW HC LLC
Other - Org Name:CREEKVIEW SKILLED NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-227-6802
Mailing Address - Street 1:2900 STONERIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2200
Mailing Address - Country:US
Mailing Address - Phone:925-201-4000
Mailing Address - Fax:925-249-9435
Practice Address - Street 1:2900 STONERIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2200
Practice Address - Country:US
Practice Address - Phone:925-201-4000
Practice Address - Fax:925-249-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003252314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555895Medicare Oscar/Certification