MEDICARE: BRENTWOOD POST ACUTE 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1760840284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENTWOOD POST ACUTE LLC

Provider Business Mailing Address
First Line	:	530 N PUENTE ST
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821-2804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1795 WALNUT ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3645
Country	:	US
Telephone Number	:	530-527-2046
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID JOHNSON
Credential	:
Telephone Number	:	888-309-0022

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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