Clinton Village Convalescent Hospital

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CLINTON VILLAGE CONVALESCENT HOSPITAL

Practice address

1833 10TH Ave
Oakland, CA 94606-3023

Phone

(510) 536-6512

Fax

(510) 536-1450

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Fermer Lukban

Title

Manager

Phone

(510) 536-6512

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Protean healthcare Other name

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154478360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 10TH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946063023",
            "telephone_number": "510-536-6512",
            "fax_number": "510-536-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 10TH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946063023",
            "telephone_number": "510-536-6512",
            "fax_number": "510-536-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON VILLAGE CONVALESCENT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUKBAN",
        "authorized_official_first_name": "FERMER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "510-536-6512"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR06341I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Protean healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Reina Lee Clifton
• Rhoda Climenhaga, L.AC.
• Joshua Cline, PTA
• Clinica la Luna Y El Sol Medical Center, Inc
• Clinical Massage Services LLC
• Clinton Village Convalescent Hospital
• Liesl Close, MD
• Kasey Lynn Cloud
• Tammy Lynette Cloud
• Gail Clough

• Skilled Nursing Facility in Oakland, CA
• Providers in Oakland, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.