Healthcare Provider Details

I. General information

NPI: 1922422450
Provider Name (Legal Business Name): SANTA CRUZ SKILLED NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 SOQUEL AVE
SANTA CRUZ CA
95062-1412
US

IV. Provider business mailing address

2990 SOQUEL AVE
SANTA CRUZ CA
95062-1412
US

V. Phone/Fax

Practice location:
  • Phone: 831-479-9000
  • Fax:
Mailing address:
  • Phone: 831-479-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000018
License Number StateCA

VIII. Authorized Official

Name: TRILOCHAN SINGH
Title or Position: CFO
Credential: CFO
Phone: 510-468-1909