Healthcare Provider Details

I. General information

NPI: 1386156206
Provider Name (Legal Business Name): LOS GATOS CARE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 LARK AVE
LOS GATOS CA
95032-7642
US

IV. Provider business mailing address

4616 W MODOC CT
VISALIA CA
93291-9384
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-3146
  • Fax: 408-317-1768
Mailing address:
  • Phone: 559-901-3147
  • Fax: 559-713-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000060
License Number StateCA

VIII. Authorized Official

Name: BRANDON DAVID BIGELOW
Title or Position: CEO & PRESIDENT
Credential:
Phone: 559-901-3147