Fruitvale Long Term Care LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FRUITVALE LONG TERM CARE LLC

Practice address

3020 E 15TH St
Oakland, CA 94601-2305

Phone

(510) 261-5613

NPI assigned

Nov 1, 2013

Organization subpart

No

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

Authorized official

Name

Kam McGavock

Title

President

Phone

(410) 773-1000

Specialties & licenses 1

Addresses

Other names 1

• Fruitvale Health Care Center Doing business as

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383264000000",
    "number": "1508295478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRUITVALE LONG TERM CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-01",
        "last_updated": "2013-11-01",
        "status": "A",
        "authorized_official_last_name": "MCGAVOCK",
        "authorized_official_first_name": "KAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-773-1000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fruitvale Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shawn Lee Fruge, PSY18275
• Fruge' Psychological Associates, Inc.
• Magalie M Fruhinsholz
• Fruits of Labor, LLC
• Fruitvale Avenue Pharmacy Inc
• Fruitvale Medical Center Pharmacy
• Fruitvale Operating Company, LP
• Francesca Fruto
• Edward John Fry, L.AC., DIPL. OM
• Alexander Frye

• 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 Nov 1, 2013; 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.