Provider Demographics
NPI:1154467835
Name:WINDSOR CHICO CREEK CARE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:WINDSOR CHICO CREEK CARE AND REHABILITATION, LLC
Other - Org Name:WINDSOR CHICO CREEK AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-1090
Mailing Address - Street 1:587 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1816
Mailing Address - Country:US
Mailing Address - Phone:530-345-1306
Mailing Address - Fax:530-342-1353
Practice Address - Street 1:587 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1816
Practice Address - Country:US
Practice Address - Phone:530-345-1306
Practice Address - Fax:530-342-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000046314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06074JMedicaid
CAZZR06074JMedicaid