Healthcare Provider Details

I. General information

NPI: 1386621357
Provider Name (Legal Business Name): EUREKA HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 23RD ST
EUREKA CA
95501-3201
US

IV. Provider business mailing address

2353 23RD ST
EUREKA CA
95501-3201
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-3261
  • Fax: 707-441-8449
Mailing address:
  • Phone: 707-445-3261
  • Fax: 707-441-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number01000054
License Number StateCA

VIII. Authorized Official

Name: MS. LINDA WAHLBAKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-445-3261