Healthcare Provider Details

I. General information

NPI: 1609872415
Provider Name (Legal Business Name): EASTERN PLUMAS HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 1ST AVE
PORTOLA CA
96122-9406
US

IV. Provider business mailing address

500 1ST AVE
PORTOLA CA
96122-9406
US

V. Phone/Fax

Practice location:
  • Phone: 530-832-6500
  • Fax: 530-832-1105
Mailing address:
  • Phone: 530-832-6500
  • Fax: 530-832-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000014
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number555433
License Number StateCA

VIII. Authorized Official

Name: MS. JERILEE NELSON
Title or Position: CFO
Credential: CPA
Phone: 530-832-6578