MEDICARE: SHADOWBROOK HEALTH CARE, 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
1	314000000X	Skilled Nursing Facility	230000059	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1669473310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADOWBROOK HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	1 GILMORE LN
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-5147
Country	:	US
Telephone Number	:	530-534-1353
Fax Number	:	530-534-0632

Provider Business Practice Location Address
First Line	:	1 GILMORE LN
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-5147
Country	:	US
Telephone Number	:	530-534-1353
Fax Number	:	530-534-0632

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TERRY BANE
Credential	:
Telephone Number	:	530-897-5100

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/20/2013

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