| Organization Name: | ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS |
| NPI Number: | 1861484982 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREMY E GRIMES (MANAGER) |
| Mailing Address: | 4432 James Ave Castro Valley |
| State: | CA US |
| Postal Code: | 945463533 |
| Phone Number: | 5108897000 |
| Fax Number: | 5108897622 |
| NPI Enumeration Date: | 08/16/2005 |
| NPI Last Update Date: | 06/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 020000104 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |