Healthcare Provider Details

I. General information

NPI: 1316083025
Provider Name (Legal Business Name): WINDSOR EL CAMINO CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 CARMICHAEL WAY
CARMICHAEL CA
95608-5314
US

IV. Provider business mailing address

2540 CARMICHAEL WAY
CARMICHAEL CA
95608-5314
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-0465
  • Fax: 916-482-7813
Mailing address:
  • Phone: 916-482-0465
  • Fax: 916-482-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. LAWRENCE FIEGEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 310-385-1090