Basic Information
Provider Information
NPI: 1033402722
EntityType: 2
ReplacementNPI:  
OrganizationName: NASAKY INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: YUBA SKILLED NURSING CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 540 W MONTE VISTA AVE
Address2:  
City: VACAVILLE
State: CA
PostalCode: 956883620
CountryCode: US
TelephoneNumber: 7074493400
FaxNumber: 7074556025
Practice Location
Address1: 521 LOREL WAY
Address2:  
City: YUBA CITY
State: CA
PostalCode: 959911913
CountryCode: US
TelephoneNumber: 5306749140
FaxNumber: 7074556025
Other Information
ProviderEnumerationDate: 05/27/2011
LastUpdateDate: 05/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: THEKKEK
AuthorizedOfficialFirstName: PREMA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE-PRESIDENT
AuthorizedOfficialTelephone: 7074493400
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X230000127CAY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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