Active NPI
Mercy Retirement and Care Center
- Skilled Nursing Facility
- Oakland, CA
National Provider Identifier
1225029366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 020000237
- Legal business name
- MERCY RETIREMENT AND CARE CENTER
- Practice address
- 3431 Foothill Blvd
Oakland, CA 94601-3129 - Phone
- (510) 534-8540
- Fax
- (510) 261-4516
- NPI assigned
- Oct 28, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Adriene Iverson
- Title
- Ceo
- Phone
- (510) 769-2700
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 020000237 | CA | Primary |
Addresses
Primary practice location
3431 Foothill Blvd
Oakland, CA 94601-3129
Mailing address
3431 Foothill Blvd
Oakland, CA 94601-3129
Phone (510) 534-8540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LTC55189F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090718000013 | CA | Part A Provider - Skilled Nursing Facility | 8729130976 | Practice locations: Oakland, CA |
Skilled nursing facility certification: CCN 555189
- Legal name
- MERCY RETIREMENT AND CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 17, 1985
- Last certification
- Feb 13, 2025
- Beds
- 59
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Jan 11, 1894 in CA
- Enrollment address
- 3431 Foothill Blvd
Oakland, CA 94601-3172 - Nursing home name
- MERCY RETIREMENT & CARE CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Mercy Retirement & Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 17, 1985
- Medicare certification status
- Active
- Certified beds
- 59
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0643822 | Mercy Retirement & Care Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Elder Care Alliance | 5% Or Greater Direct Ownership Interest | Jan 17, 1985 | 100% |
| Mark Krueger | W-2 Managing Employee | Nov 9, 2016 | |
| Geraldine McGrath | Corporate Director | Dec 1, 2020 | |
| Raelynne Benham-Dwyer | W-2 Managing Employee | Aug 11, 2022 | |
| Blaine Lyons | W-2 Managing Employee | May 11, 2017 | |
| Robin Evitts | Corporate Officer | May 6, 2019 | |
| Nicole L Foreman | W-2 Managing Employee | Sep 16, 2019 | |
| Marjorie Balley | Corporate Officer | Nov 9, 2013 | |
| Lynn Katzmann | Corporate Director | Dec 1, 2012 | |
| Adriene M Iverson | Corporate Officer | Apr 1, 2015 | |
| Christine Whelan | Corporate Director | Dec 1, 2011 | |
| Rahul S Joglekar | Corporate Director | May 19, 2009 |
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130457600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529539200000",
"number": "1225029366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3431 FOOTHILL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946013129",
"telephone_number": "510-534-8540",
"fax_number": "510-261-4516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3431 FOOTHILL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946013129",
"telephone_number": "510-534-8540",
"fax_number": "510-261-4516"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERCY RETIREMENT AND CARE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-28",
"last_updated": "2018-06-21",
"status": "A",
"authorized_official_last_name": "IVERSON",
"authorized_official_first_name": "ADRIENE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "510-769-2700",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "020000237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LTC55189F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.