1386898203 NPI number — VETERANS HOME OF CALIFORNIA

Table of content: (NPI 1386898203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386898203 NPI number — VETERANS HOME OF CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
VETERANS HOME OF CALIFORNIA
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:
VETERANS HOME OF CALIFORNIA-YOUNTVILLE
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:
1386898203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 942895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94295-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-657-9349
Provider Business Mailing Address Fax Number:
916-653-1795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CALIFORNIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNTVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94599-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-944-4716
Provider Business Practice Location Address Fax Number:
707-944-5052
Provider Enumeration Date:
11/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERERKA
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
L..
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
707-944-4501

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  150000494 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 150000494 , 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: DA1272 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".