Healthcare Provider Details

I. General information

NPI: 1578615464
Provider Name (Legal Business Name): CF WATSONVILLE EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 AUTO CENTER DRIVE
WATSONVILLE CA
95076
US

IV. Provider business mailing address

535 AUTO CENTER DRIVE
WATSONVILLE CA
95076
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-7505
  • Fax: 831-763-0141
Mailing address:
  • Phone: 831-724-7505
  • Fax: 831-763-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000129
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: JACOB WINTNER
Title or Position: MANAGER
Credential:
Phone: 323-651-1808