Provider Demographics
NPI:1811521073
Name:WELDWOODS RESIDENTIAL CARE HOME LLC
Entity type:Organization
Organization Name:WELDWOODS RESIDENTIAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOKIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-470-2881
Mailing Address - Street 1:928 WELDWOOD CT APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1350
Mailing Address - Country:US
Mailing Address - Phone:510-470-2881
Mailing Address - Fax:
Practice Address - Street 1:1490 PELUSA LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8792
Practice Address - Country:US
Practice Address - Phone:510-470-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care