Healthcare Provider Details

I. General information

NPI: 1477552164
Provider Name (Legal Business Name): UNITED COM-SERVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 WILLIAMS WAY
YUBA CITY CA
95991-2400
US

IV. Provider business mailing address

1260 WILLIAMS WAY
YUBA CITY CA
95991-2400
US

V. Phone/Fax

Practice location:
  • Phone: 530-790-3000
  • Fax: 530-751-4894
Mailing address:
  • Phone: 530-790-3000
  • Fax: 530-751-4894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000176
License Number StateCA

VIII. Authorized Official

Name: MRS. EMMA NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 530-790-3002