Provider Demographics
NPI:1194891051
Name:REDWOOD CONVALESCENT HOSPITAL, INC
Entity type:Organization
Organization Name:REDWOOD CONVALESCENT HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUNINGNING
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:510-537-8848
Mailing Address - Street 1:22103 REDWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546
Mailing Address - Country:US
Mailing Address - Phone:510-537-8848
Mailing Address - Fax:510-537-3830
Practice Address - Street 1:22103 REDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-537-8848
Practice Address - Fax:510-537-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020000298314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05620IMedicaid
CA555341Medicare ID - Type Unspecified