Healthcare Provider Details

I. General information

NPI: 1386843167
Provider Name (Legal Business Name): VETERANS HOME OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CALIFORNIA DRIVE
YOUNTVILLE CA
94599
US

IV. Provider business mailing address

123 CALIFORNIA DRIVE
YOUNTVILLE CA
94599
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4616
  • Fax: 707-944-4629
Mailing address:
  • Phone: 707-944-4616
  • Fax: 707-944-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHE 19563
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHE 19563
License Number StateCA

VIII. Authorized Official

Name: MS. SARAH KATE
Title or Position: PHARMACY SERVICES MANAGER
Credential: PHARMACIST
Phone: 707-944-4616