Healthcare Provider Details

I. General information

NPI: 1841336534
Provider Name (Legal Business Name): WINDSOR COUNTRY DRIVE 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

2500 COUNTRY DR
FREMONT CA
94536-5356
US

IV. Provider business mailing address

2500 COUNTRY DR
FREMONT CA
94536-5356
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-4242
  • Fax: 510-797-2074
Mailing address:
  • Phone: 510-792-4242
  • Fax: 510-797-2074

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