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General NPI Number Information
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NPI Number | 1679505572
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Entity Type | Organization
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Legal Business Name | BLUFF ENTERPRISES CORP
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 510 MILL ST
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City | FOLSOM
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State | CA
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Zip | 95630-2607
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Country | US
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Telephone | 916-985-3641
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Fax | 916-985-7231
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Provider Business Mailing Address
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Address Line | 510 MILL ST
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City | FOLSOM
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State | CA
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Zip | 95630-2607
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Country | US
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Telephone | 916-985-3641
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Fax | 916-985-7231
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CALVIN WADE CALLAWAY
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Credential |
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Telephone | 916-985-3641
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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 | 030000040
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License Number State | CA
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