Common Destiny LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COMMON DESTINY LLC

Practice address

34209 Sylvester Dr
Fremont, CA 94555-2227

Phone

(510) 794-4931

NPI assigned

Mar 7, 2024

Organization subpart

No

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

Authorized official

Name

Marvin Tom

Title

Administrator

Phone

(415) 519-0306

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1386402014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 EVELYN WAY",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941271730",
            "telephone_number": "415-519-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34209 SYLVESTER DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945552227",
            "telephone_number": "510-794-4931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMON DESTINY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "TOM",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "415-519-0306"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Fremont, CA
• Providers in Fremont, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.