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General NPI Number Information
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NPI Number | 1205826690
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Entity Type | Organization
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Legal Business Name | VINTAGE ESTATES INC
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 501 JESSIE AVE
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City | SACRAMENTO
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State | CA
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Zip | 94588
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Country | US
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Telephone | 916-922-8855
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Fax | 916-922-6208
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Provider Business Mailing Address
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Address Line | 25919 GADING RD 1
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City | HAYWARD
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State | CA
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Zip | 94544-2725
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Country | US
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Telephone | 510-782-3825
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Fax | 510-782-8793
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SALLY JANE RAPP
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Credential |
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Telephone | 510-782-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 142744
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License Number State | CA
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