Provider Demographics
NPI:1124807730
Name:CASTRO VALLEY RESIDENTIAL CARE HOME LLC
Entity type:Organization
Organization Name:CASTRO VALLEY RESIDENTIAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MA OHNMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHWE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:510-789-7064
Mailing Address - Street 1:1932 GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6956
Mailing Address - Country:US
Mailing Address - Phone:510-789-7064
Mailing Address - Fax:
Practice Address - Street 1:1932 GROVE WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6956
Practice Address - Country:US
Practice Address - Phone:510-789-7064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility