Healthcare Provider Details

I. General information

NPI: 1255938015
Provider Name (Legal Business Name): NEWPORT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 EVERGREEN AVE
MODESTO CA
95350-3785
US

IV. Provider business mailing address

599 MENLO DR STE 200
ROCKLIN CA
95765-3725
US

V. Phone/Fax

Practice location:
  • Phone: 916-899-1315
  • Fax:
Mailing address:
  • Phone: 916-899-1315
  • 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: RYAN WILLIAMS
Title or Position: PARTNER
Credential:
Phone: 916-945-1248