Provider Demographics
NPI:1427089754
Name:WASHINGTON TOWNSHIP HOSPITAL DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:WASHINGTON TOWNSHIP HOSPITAL DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-745-6500
Mailing Address - Street 1:2500 MOWRY AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1605
Mailing Address - Country:US
Mailing Address - Phone:510-608-6174
Mailing Address - Fax:510-745-6435
Practice Address - Street 1:2500 MOWRY AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1605
Practice Address - Country:US
Practice Address - Phone:510-608-6174
Practice Address - Fax:510-745-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000653261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01584ZOtherBLUE SHIELD GROUP PROV#
CACMM70953FMedicaid
CACMM70953FMedicaid