Basic Information
| Provider Information | |||||||||
| NPI: | 1154467835 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WINDSOR CHICO CREEK CARE AND REHABILITATION, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINDSOR CHICO CREEK AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 587 RIO LINDO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303451306 | ||||||||
| FaxNumber: | 5303421353 | ||||||||
| Practice Location | |||||||||
| Address1: | 587 RIO LINDO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303451306 | ||||||||
| FaxNumber: | 5303421353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHAWLA | ||||||||
| AuthorizedOfficialFirstName: | ASH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3103851090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 230000046 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR06074J | 05 | CA | MEDICAID |