Provider Demographics
NPI:1205821758
Name:VETERANS HOME OF CALIFORNIA BARSTOW
Entity Type:Organization
Organization Name:VETERANS HOME OF CALIFORNIA BARSTOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-252-6250
Mailing Address - Street 1:100 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-7003
Mailing Address - Country:US
Mailing Address - Phone:760-252-6200
Mailing Address - Fax:760-252-6333
Practice Address - Street 1:100 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-7003
Practice Address - Country:US
Practice Address - Phone:760-252-6200
Practice Address - Fax:760-252-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170000835313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC90083FMedicaid
CAZZZ15035ZMedicare PIN
CALTC90083FMedicaid