Healthcare Provider Details

I. General information

NPI: 1891847364
Provider Name (Legal Business Name): CF QUINCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 04/18/2008

III. Provider practice location address

50 EAST CENTRAL AVENUE
QUINCY CA
95971
US

IV. Provider business mailing address

50 EAST CENTRAL AVENUE
QUINCY CA
95971
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-2110
  • Fax: 530-283-2274
Mailing address:
  • Phone: 530-283-2110
  • Fax: 530-283-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000050
License Number StateCA

VIII. Authorized Official

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