Healthcare Provider Details

I. General information

NPI: 1114914355
Provider Name (Legal Business Name): VACAVILLE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 NUT TREE CT
VACAVILLE CA
95687-3353
US

IV. Provider business mailing address

585 NUT TREE CT
VACAVILLE CA
95687-3353
US

V. Phone/Fax

Practice location:
  • Phone: 707-449-8000
  • Fax: 707-449-4166
Mailing address:
  • Phone: 707-449-8000
  • Fax: 707-449-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH MARTIN NICCOLI JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-449-8000