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General NPI Number Information
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NPI Number | 1679919856
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Entity Type | Organization
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Legal Business Name | CAPITAL MEDICAL EXTENDED CARE
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 6608 MERCY CT STE C
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City | FAIR OAKS
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State | CA
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Zip | 95628-3171
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Country | US
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Telephone | 916-241-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 7190 SIERRA DR
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City | GRANITE BAY
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State | CA
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Zip | 95746-9583
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Country | US
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Telephone | 408-768-6866
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHANDAN CHEEMA
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Credential | M.D.
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Telephone | 916-241-9844
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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 |
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License Number State |
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