Provider Demographics
NPI:1194120600
Name:FREMONT HEALTHCARE OPERATING COMPANY, LP
Entity type:Organization
Organization Name:FREMONT HEALTHCARE 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 1:39022 PRESIDIO WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1221
Mailing Address - Country:US
Mailing Address - Phone:510-792-3743
Mailing Address - Fax:510-793-6108
Practice Address - Street 1:39022 PRESIDIO WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1221
Practice Address - Country:US
Practice Address - Phone:510-792-3743
Practice Address - Fax:510-793-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020000025314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06442LMedicaid
CA056422Medicare Oscar/Certification