Provider Demographics
NPI:1235275975
Name:WINDSOR ELK GROVE CARE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:WINDSOR ELK GROVE CARE AND REHABILITATION, LLC
Other - Org Name:WINDSOR ELK GROVE CARE 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 1:9461 BATEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2005
Mailing Address - Country:US
Mailing Address - Phone:916-685-9525
Mailing Address - Fax:916-685-3373
Practice Address - Street 1:9200 W SUNSET BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3502
Practice Address - Country:US
Practice Address - Phone:310-385-1090
Practice Address - Fax:310-595-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05308IMedicaid
CAZZR05308IMedicaid