1861493504 NPI number — BRENTWOOD SKILLED NURSING CENTER, INC.

Table of content: (NPI 1861493504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861493504 NPI number — BRENTWOOD SKILLED NURSING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENTWOOD SKILLED NURSING CENTER, INC.
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:
BRENTWOOD SKILLED NURSING & REHABILITATION 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:
1861493504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1795 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BLUFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96080-3645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-527-2046
Provider Business Mailing Address Fax Number:
530-527-8737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1795 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-3645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-2046
Provider Business Practice Location Address Fax Number:
530-527-8737
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BANE
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-897-5100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  230000043 , 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: ZZR05489H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com