Healthcare Provider Details

I. General information

NPI: 1669830667
Provider Name (Legal Business Name): SHASTA VIEW ESTATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PARK ST
WEED CA
96094-2332
US

IV. Provider business mailing address

445 PARK ST
WEED CA
96094-2332
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-4429
  • Fax: 530-938-4449
Mailing address:
  • Phone: 530-938-4429
  • Fax: 530-938-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KENT M EMRY
Title or Position: PRESIDENT
Credential:
Phone: 503-689-1808