Peninsula Convalescent Associates LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

220000004 Issued in CA

Legal business name

PENINSULA CONVALESCENT ASSOCIATES LLC

Practice address

2140 Carlmont Dr
Belmont, CA 94002-3417

Phone

(650) 591-9601

Fax

(650) 591-2446

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Linda Ann Vieira

Title

Controller

Phone

(650) 591-9601

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CARLMONT GARDENS NURSING CENTER Doing business as

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1386732006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 CARLMONT DR",
            "city": "BELMONT",
            "state": "CA",
            "postal_code": "940023417",
            "telephone_number": "650-591-9601",
            "fax_number": "650-591-2446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 CARLMONT DR",
            "city": "BELMONT",
            "state": "CA",
            "postal_code": "940023417",
            "telephone_number": "650-591-9601",
            "fax_number": "650-591-2446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA CONVALESCENT ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "VIEIRA",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "650-591-9601"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "220000004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55657G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARLMONT GARDENS NURSING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Soyon Park, PH.D.
• John S. Parke, PSY.D.
• Dharmesh Patel, M.D.
• Patricia Kim
• Penguinsmart Inc.
• Peninsula Specialty Care
• Peninsula Specialty Dental Care
• Ericka Elizabeth Perez, RAS
• Vincent S. Perez, MD
• Laura Petix, MS, OTR/L

• Skilled Nursing Facility in Belmont, CA
• Providers in Belmont, 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 Dec 6, 2012; 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.