Healthcare Provider Details

I. General information

NPI: 1932251808
Provider Name (Legal Business Name): CF MODESTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EAST ORANGEBURG AVENUE
MODESTO CA
95350
US

IV. Provider business mailing address

159 EAST ORANGEBURG AVENUE
MODESTO CA
95350
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-2811
  • Fax: 209-526-6193
Mailing address:
  • Phone: 209-526-2811
  • Fax: 209-526-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000118
License Number StateCA

VIII. Authorized Official

Name: JACOB WINTNER
Title or Position: MANAGER
Credential:
Phone: 323-651-1808