| NPI | 1861484982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY E GRIMES Manager 925-855-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: CA 020000104) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 020000104) |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: CA 020000104) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: CA 020000104) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2011-06-23 |