Fair Oaks Residential Treatment Facility, LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

FAIR OAKS RESIDENTIAL TREATMENT FACILITY, LLC

Practice address

1782 B St
Hayward, CA 94541-3102

Phone

(916) 458-4100

NPI assigned

Jan 19, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Alex Rudakov

Title

Secretary

Phone

(415) 812-2955

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1114679305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 ZANKER RD STE 106",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951342121",
            "telephone_number": "415-812-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1782 B ST",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413102",
            "telephone_number": "916-458-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR OAKS RESIDENTIAL TREATMENT FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "RUDAKOV",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "415-812-2955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tatiana Fabela
• Claudia Fabiani
• Norman Apellido Factora
• Deeda Halima Fahim
• Kevin Fain, NP
• Seth Taylor Gale Fairchild
• Mumtaz Faisal, PHARM.D
• Germione Yllyandra Faith Villegas
• Oliver Fajardo, RN
• Rosaremo Fajardo, RN,BSN

• Nursing Care Agency in Hayward, CA
• Providers in Hayward, CA by specialty
• Nursing Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.