Provider Demographics
NPI:1972851392
Name:MERIDIAN HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:MERIDIAN HEALTH SERVICES CORPORATION
Other - Org Name:ALL SAINTS SUBACUTE AND REHABILITATION CENTER - MAUBERT SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PREIMESBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-855-0881
Mailing Address - Street 1:1652 MONO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2020
Mailing Address - Country:US
Mailing Address - Phone:510-481-3200
Mailing Address - Fax:510-278-7912
Practice Address - Street 1:15731 MAUBERT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2014
Practice Address - Country:US
Practice Address - Phone:510-481-3200
Practice Address - Fax:510-278-7912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN HEALTH SERVICES HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA206014308OtherOSHPD
CA55-5879OtherMEDICARE ID - TYPE UNSPECIFIED
CA550002156OtherLICENSE
CA1972851392OtherNPI