Healthcare Provider Details

I. General information

NPI: 1780431817
Provider Name (Legal Business Name): SOQUEL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 SOQUEL AVE
SANTA CRUZ CA
95062-1412
US

IV. Provider business mailing address

6205 RUTHERFORD CANYON RD
LOOMIS CA
95650-9472
US

V. Phone/Fax

Practice location:
  • Phone: 916-416-4285
  • Fax:
Mailing address:
  • Phone: 916-416-4285
  • 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: MR. SCOTT SUCHOMEL
Title or Position: OFFICER
Credential:
Phone: 916-416-4285