Provider Demographics
NPI:1972601987
Name:VIP CARE MANAGEMENT INC
Entity Type:Organization
Organization Name:VIP CARE MANAGEMENT INC
Other - Org Name:ASHBY CARE CENTER ASHBY GERIATRIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDIACHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-867-4033
Mailing Address - Street 1:55 DIAS COURT
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803
Mailing Address - Country:US
Mailing Address - Phone:510-223-1252
Mailing Address - Fax:510-223-1252
Practice Address - Street 1:2270 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-841-9494
Practice Address - Fax:510-841-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTM90004 IMedicaid
555466Medicare ID - Type Unspecified