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NPI Code Detail

MEDICARE: WINDSOR HEALTHCARE GOLDEN PALMS LLC

MEDICARE: WINDSOR HEALTHCARE GOLDEN PALMS 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 Facility090000052CA

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 : 1811963028
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDSOR HEALTHCARE GOLDEN PALMS LLC
Provider Business Mailing Address
First Line : 1201 34TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2416
Country : US
Telephone Number : 619-232-2946
Fax Number : 619-232-4665
Provider Business Practice Location Address
First Line : 1201 34TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2416
Country : US
Telephone Number : 619-232-2946
Fax Number : 619-232-4665
Authorized Official
Title or Position : COO
Name : MR. LAWRENCE E FIEGEN
Credential :
Telephone Number : 310-385-1090
Provider Enumeration Date : 02/27/2006
Last Update Date : 02/13/2012

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Directions to “WINDSOR HEALTHCARE GOLDEN PALMS LLC ” Practice Location

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