SSC Oakland Fruitvale Operating Company LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

020000067 Issued in CA

Legal business name

SSC OAKLAND FRUITVALE OPERATING COMPANY LP

Practice address

3020 E 15TH St
Oakland, CA 94601-2305

Phone

(510) 261-5613

Fax

(510) 261-5940

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Kelle C Santoro

Title

Sr Director Ar

Phone

(832) 467-5728

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fruitvale Healthcare Center Doing business as

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1275670895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 W SAM HOUSTON PKWY N",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770415161",
            "telephone_number": "832-467-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 E 15TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012305",
            "telephone_number": "510-261-5613",
            "fax_number": "510-261-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC OAKLAND FRUITVALE OPERATING COMPANY LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "SANTORO",
        "authorized_official_first_name": "KELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SR DIRECTOR AR",
        "authorized_official_telephone_number": "832-467-5728"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "020000067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC90060H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fruitvale Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Padma Srinivasan, M.D.
• Sathvik Sriram
• Shivani Srivastav
• Neha Srivastava
• SSC Oakland Excell Operating Company LP
• Anna Nansamba Ssensalo, OTR/L
• Holly St James
• Matilda Ann St John, MFT
• Rachel St Julian
• Carla C St Juste, M.S.W.,

• 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 Apr 9, 2015; 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.