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NPI Code Detail

MEDICARE: WOOD'S RETREAT

MEDICARE: WOOD'S RETREAT
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
1310400000XAssisted Living Facility340306720CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1340306720OTHERCACALIFORNIA

General Provider Information

NPI Number : 1962749333
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOOD'S RETREAT
Provider Business Mailing Address
First Line : 7415 HENRIETTA DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95822-5142
Country : US
Telephone Number : 916-421-5845
Fax Number : 916-880-5451
Provider Business Practice Location Address
First Line : 7415 HENRIETTA DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95822-5142
Country : US
Telephone Number : 916-421-5845
Fax Number : 916-880-5451
Authorized Official
Title or Position : GENERAL PARTNER
Name : MRS. REMA P STOUT
Credential :
Telephone Number : 916-421-5845
Provider Enumeration Date : 01/05/2013
Last Update Date : 01/05/2013

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Directions to “WOOD'S RETREAT ” Practice Location

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