Healthcare Provider Details

I. General information

NPI: 1104811751
Provider Name (Legal Business Name): VETERANS HOME OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALIFORNIA DR
YOUNTVILLE CA
94599-1411
US

IV. Provider business mailing address

PO BOX 942895
SACRAMENTO CA
94295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4450
  • Fax: 707-944-5052
Mailing address:
  • Phone: 916-657-9349
  • Fax: 916-653-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number150000494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number150000494
License Number StateCA

VIII. Authorized Official

Name: MR. DONALD L. VEVERKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-944-4501