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NPI Code Detail

MEDICARE: WINDSOR VALLEJO CARE CENTER, LLC

MEDICARE: WINDSOR VALLEJO CARE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285770669
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDSOR VALLEJO CARE CENTER, LLC
Provider Business Mailing Address
First Line : 2200 TUOLUMNE ST
Second Line :
City : VALLEJO
State : CA
Zip : 94589-2523
Country : US
Telephone Number : 707-644-7401
Fax Number : 707-558-8165
Provider Business Practice Location Address
First Line : 2200 TUOLUMNE ST
Second Line :
City : VALLEJO
State : CA
Zip : 94589-2523
Country : US
Telephone Number : 707-644-7401
Fax Number : 707-558-8165
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. LAWRENCE FIEGEN
Credential :
Telephone Number : 310-385-1090
Provider Enumeration Date : 01/30/2007
Last Update Date : 08/22/2020

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