Healthcare Provider Details

I. General information

NPI: 1437158748
Provider Name (Legal Business Name): MONTEREY PINES SKILLED NURSING FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SKYLINE DR
MONTEREY CA
93940-4110
US

IV. Provider business mailing address

4020 SIERRA COLLEGE BLVD STE 190
ROCKLIN CA
95677-3906
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-3716
  • Fax: 831-373-8102
Mailing address:
  • Phone: 916-624-6230
  • Fax: 916-624-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000089
License Number StateCA

VIII. Authorized Official

Name: LARRY E BEAR
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 916-624-6230