Healthcare Provider Details

I. General information

NPI: 1861493504
Provider Name (Legal Business Name): BRENTWOOD SKILLED NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 11/20/2013
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

1795 WALNUT ST
RED BLUFF CA
96080-3645
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-2046
  • Fax: 530-527-8737
Mailing address:
  • Phone: 530-527-2046
  • Fax: 530-527-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000043
License Number StateCA

VIII. Authorized Official

Name: MR. TERRY BANE
Title or Position: PRESIDENT
Credential:
Phone: 530-897-5100