NPIMap

Organization Active NPI

Shattuck Healthcare Inc. Dba Elmwood Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Berkeley, CA
National Provider Identifier
1609885920
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SHATTUCK HEALTHCARE INC. DBA ELMWOOD NURSING AND REHABILITATION CENTER
Practice address
2829 Shattuck Ave
Berkeley, CA 94705-1037
Phone
(510) 665-2800
Fax
(510) 665-2808
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Luzviminda G Lukban
Title
Administrator
Phone
(510) 665-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X CA Primary

Addresses

Primary practice location

2829 Shattuck Ave
Berkeley, CA 94705-1037

Mailing address

2829 Shattuck Ave
Berkeley, CA 94705-1037
Phone (510) 665-2800

Other identifiers 1

IdentifierTypeStateIssuer
LTC55819FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Elmwood Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609885920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 SHATTUCK AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051037",
            "telephone_number": "510-665-2800",
            "fax_number": "510-665-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 SHATTUCK AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051037",
            "telephone_number": "510-665-2800",
            "fax_number": "510-665-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHATTUCK HEALTHCARE INC. DBA ELMWOOD NURSING AND REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUKBAN",
        "authorized_official_first_name": "LUZVIMINDA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "510-665-2800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55819F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.