Provider Demographics
NPI:1225119803
Name:COURTYARD HEALTHCARE CENTER
Entity Type:Organization
Organization Name:COURTYARD HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:ORMISTON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:530-756-1800
Mailing Address - Street 1:1850 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2502
Mailing Address - Country:US
Mailing Address - Phone:530-756-1800
Mailing Address - Fax:530-759-1859
Practice Address - Street 1:1850 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2502
Practice Address - Country:US
Practice Address - Phone:530-756-1800
Practice Address - Fax:530-759-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05922IMedicaid
CAZZR05922IMedicaid