Provider Demographics
NPI:1952485690
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL HOME HEALTH AGENCY OAKLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-752-2972
Mailing Address - Street 1:4501 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4615
Mailing Address - Country:US
Mailing Address - Phone:510-752-6295
Mailing Address - Fax:510-752-1604
Practice Address - Street 1:4501 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4615
Practice Address - Country:US
Practice Address - Phone:510-752-6295
Practice Address - Fax:510-752-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020000349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557068Medicare Oscar/Certification