Basic Information
| Provider Information | |||||||||
| NPI: | 1851562664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUTTE PARK ROYAL OPERATIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CROW CANYON CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253620354 | ||||||||
| FaxNumber: | 9253628470 | ||||||||
| Practice Location | |||||||||
| Address1: | 3251 NETTIE ST | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597016531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067233225 | ||||||||
| FaxNumber: | 4067236470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | GILL | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9253620354 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.