Provider Demographics
NPI:1912072554
Name:SANHYD, INC
Entity Type:Organization
Organization Name:SANHYD, INC
Other - Org Name:KYAKAMEENA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:PODDATOORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-677-3566
Mailing Address - Street 1:524 CALLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4610
Mailing Address - Country:US
Mailing Address - Phone:510-352-3402
Mailing Address - Fax:510-352-8530
Practice Address - Street 1:2131 CARLETON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3213
Practice Address - Country:US
Practice Address - Phone:510-843-2131
Practice Address - Fax:510-843-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02 0000055314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055715Medicare Oscar/Certification
CA05-5715Medicare ID - Type UnspecifiedMEDICARE NUMBER