1568616480 NPI number — VETERANS HOME OF CALIFORNIA

Table of content: (NPI 1568616480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568616480 NPI number — VETERANS HOME OF CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
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:
Provider Other Organization Name Type Code:
6
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:
1568616480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
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:
916-653-0080
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:
MEDICAL STAFF OFFICE
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:
MCCORMACK
Authorized Official First Name:
MARCELLA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
707-944-4501

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  15000494 , 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".




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