1730269184 NPI number — O'CONNOR WOODS HOUSING CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730269184 NPI number — O'CONNOR WOODS HOUSING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'CONNOR WOODS HOUSING CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEADOWOOD HEALTH & REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730269184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5105 MANZANITA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-0523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-334-0810
Provider Business Mailing Address Fax Number:
916-338-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 WAGNER HEIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95209-4848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-956-3444
Provider Business Practice Location Address Fax Number:
209-956-3454
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-334-0810

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100000631 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7538839 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100000631 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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