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NPI Code Detail

MEDICARE: WINDSOR RIDGECREST, LLC

MEDICARE: WINDSOR RIDGECREST, LLC
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 Facility

General Provider Information

NPI Number : 1316297013
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDSOR RIDGECREST, LLC
Provider Business Mailing Address
First Line : 9200 SUNSET BLVD.
Second Line : SUITE 700 C/O S&F MANAGEMENT COMPANY, LLC,
City : WEST HOLLYWOOD
State : CA
Zip : 90069-3603
Country : US
Telephone Number : 310-385-1076
Fax Number : 310-595-3736
Provider Business Practice Location Address
First Line : 16640 N 38TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2103
Country : US
Telephone Number : 602-482-6671
Fax Number : 602-482-3541
Authorized Official
Title or Position : MANAGING MEMBER, WINDSOR OMG HOLDIN
Name : LEE SAMSON
Credential :
Telephone Number : 310-385-1090
Provider Enumeration Date : 09/11/2012
Last Update Date : 04/30/2013

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Directions to “WINDSOR RIDGECREST, LLC ” Practice Location

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