Healthcare Provider Details

I. General information

NPI: 1649184029
Provider Name (Legal Business Name): SPANISH VINES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7548 GREENHAVEN DR
SACRAMENTO CA
95831-5610
US

IV. Provider business mailing address

2334 WASHINGTON AVE
REDDING CA
96001-2159
US

V. Phone/Fax

Practice location:
  • Phone: 916-596-1887
  • Fax:
Mailing address:
  • Phone: 530-242-8300
  • Fax: 530-244-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: TREVOR ARTHUR OGDEN
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 530-356-8699