Healthcare Provider Details

I. General information

NPI: 1285016188
Provider Name (Legal Business Name): WINDSOR MODESTO HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 EVERGREEN AVE
MODESTO CA
95350-3785
US

IV. Provider business mailing address

2030 EVERGREEN AVE
MODESTO CA
95350-3785
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-1055
  • Fax:
Mailing address:
  • Phone: 209-577-1055
  • Fax:

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 FEIGEN
Title or Position: MANAGING MEMBER
Credential:
Phone: 310-385-1090