Healthcare Provider Details

I. General information

NPI: 1679505572
Provider Name (Legal Business Name): BLUFF ENTERPRISES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MILL ST
FOLSOM CA
95630-2607
US

IV. Provider business mailing address

510 MILL ST
FOLSOM CA
95630-2607
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-3641
  • Fax: 916-985-7231
Mailing address:
  • Phone: 916-985-3641
  • Fax: 916-985-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000040
License Number StateCA

VIII. Authorized Official

Name: CALVIN WADE CALLAWAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-985-3641