MEDICARE: GOLDEN EMPIRE NURSING & REHAB CENTER LP

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	230000135	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	:	1710089255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN EMPIRE NURSING & REHAB CENTER LP

Provider Business Mailing Address
First Line	:	121 DORSEY DR
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5201
Country	:	US
Telephone Number	:	530-273-1316
Fax Number	:	530-273-4809

Provider Business Practice Location Address
First Line	:	121 DORSEY DR
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5201
Country	:	US
Telephone Number	:	530-273-1316
Fax Number	:	530-273-4809

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VICKI YOUNG
Credential	:
Telephone Number	:	530-273-1316

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	12/22/2016

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