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NPI Code Detail

MEDICARE: VACAVILLE HEALTHCARE INC

MEDICARE: VACAVILLE HEALTHCARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility110000203CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114914355
Entity Type Code : Organization
Provider Name (Legal Business Name) : VACAVILLE HEALTHCARE INC
Provider Business Mailing Address
First Line : 585 NUT TREE CT
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-3353
Country : US
Telephone Number : 707-449-8000
Fax Number : 707-449-4166
Provider Business Practice Location Address
First Line : 585 NUT TREE CT
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-3353
Country : US
Telephone Number : 707-449-8000
Fax Number : 707-449-4166
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. JOSEPH MARTIN NICCOLI JR.
Credential :
Telephone Number : 707-449-8000
Provider Enumeration Date : 10/03/2005
Last Update Date : 01/08/2026

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Directions to “VACAVILLE HEALTHCARE INC ” Practice Location

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