Healthcare Provider Details

I. General information

NPI: 1679919856
Provider Name (Legal Business Name): CAPITAL MEDICAL EXTENDED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 MERCY CT STE C
FAIR OAKS CA
95628-3171
US

IV. Provider business mailing address

7190 SIERRA DR
GRANITE BAY CA
95746-9583
US

V. Phone/Fax

Practice location:
  • Phone: 916-241-9844
  • Fax:
Mailing address:
  • Phone: 408-768-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHANDAN CHEEMA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 916-241-9844