Provider Demographics
NPI:1972642387
Name:MCARLSON, INC.
Entity type:Organization
Organization Name:MCARLSON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZENAIDA
Authorized Official - Middle Name:CABATO
Authorized Official - Last Name:ROSETE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-523-3772
Mailing Address - Street 1:625 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5711
Mailing Address - Country:US
Mailing Address - Phone:510-523-3772
Mailing Address - Fax:510-523-9629
Practice Address - Street 1:625 WILLOW ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5711
Practice Address - Country:US
Practice Address - Phone:510-523-3772
Practice Address - Fax:510-523-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0200001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA341-08035OtherCA ID
CALTC55359FMedicaid
CA0200001OtherSTATE DEPT. LICENSE
CA555359Medicare ID - Type Unspecified