Provider Demographics
NPI:1780972463
Name:SKYLINE SAN JOSE OPERATING COMPANY, LP
Entity type:Organization
Organization Name:SKYLINE SAN JOSE OPERATING COMPANY, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL FINANCIAL ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-208-1940
Mailing Address - Street 1:2065 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4807
Mailing Address - Country:US
Mailing Address - Phone:408-280-2500
Mailing Address - Fax:408-298-1228
Practice Address - Street 1:2065 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4807
Practice Address - Country:US
Practice Address - Phone:408-280-2500
Practice Address - Fax:408-298-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000110314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055318Medicare Oscar/Certification