Healthcare Provider Details

I. General information

NPI: 1457649436
Provider Name (Legal Business Name): DRIFTWOOD SANTA CRUZ OPERATING COMPANY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 24TH AVE
SANTA CRUZ CA
95062-4205
US

IV. Provider business mailing address

675 24TH AVE
SANTA CRUZ CA
95062-4205
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-6323
  • Fax: 831-475-6814
Mailing address:
  • Phone: 831-475-6323
  • Fax: 831-475-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000033
License Number StateCA

VIII. Authorized Official

Name: MRS. ANDREA SAAVEDRA
Title or Position: REGIONAL FINANCIAL ANALYST
Credential:
Phone: 707-208-1940