Provider Demographics
NPI:1194895631
Name:COVIA COMMUNITIES
Entity type:Organization
Organization Name:COVIA COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE/CORPORATE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-956-7410
Mailing Address - Street 1:2185 N CALIFORNIA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3566
Mailing Address - Country:US
Mailing Address - Phone:925-956-7400
Mailing Address - Fax:925-407-0060
Practice Address - Street 1:100 WOOD RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6704
Practice Address - Country:US
Practice Address - Phone:408-354-0211
Practice Address - Fax:408-354-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000062314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
056290Medicare Oscar/Certification