Provider Demographics
NPI:1235367913
Name:COVENANT CARE COURTYARD, LLC
Entity Type:Organization
Organization Name:COVENANT CARE COURTYARD, LLC
Other - Org Name:COURTYARD HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-349-1200
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:530-756-1859
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:530-756-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05992IMedicaid
CA055922Medicare Oscar/Certification