Healthcare Provider Details

I. General information

NPI: 1760840284
Provider Name (Legal Business Name): BRENTWOOD POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 WALNUT ST
RED BLUFF CA
96080-3645
US

IV. Provider business mailing address

530 N PUENTE ST
BREA CA
92821-2804
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-2046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID JOHNSON
Title or Position: CEO
Credential:
Phone: 888-309-0022