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ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS NPI 1861484982


NPI Information

NPI: 1861484982
Provider Name: ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS
Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization

CLIA Number: 05D0725937

Address:
4432 JAMES AVE
CASTRO VALLEY, CA
ZIP 94546
Phone: (510) 889-7000
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ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS is a skilled nursing facility in Castro Valley, CA. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS NPI is 1861484982. The provider is registered as an organization entity type.

The provider's business location address is:

4432 JAMES AVE
CASTRO VALLEY, CA
ZIP 94546-533
Phone: (510) 889-7000
Fax: (510) 889-7622

The provider's authorized official is Jeremy E Grimes .
The authorized official title is Manager and has the following contact phone number (925) 855-0881.

The CLIA number assigned to this NPI record is 05D0725937 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2005 and was last updated on 6/23/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical Supplies020000104CALIFORNIANo
2332BN1400XDurable Medical Equipment & Medical SuppliesNursing Facility Supplies020000104CALIFORNIANo
3332BP3500XDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition020000104CALIFORNIANo
4314000000XSkilled Nursing Facility020000104CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
155-5016MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
20761380001MEDICARE NSCCALIFORNIA
3ZZR 55016GMEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.