Provider Demographics
NPI:1285016188
Name:WINDSOR MODESTO HEALTHCARE, LLC
Entity Type:Organization
Organization Name:WINDSOR MODESTO HEALTHCARE, LLC
Other - Org Name:WINDSOR POST-ACUTE HEALTHCARE CENTER OF MODESTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-1090
Mailing Address - Street 1:2030 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3785
Mailing Address - Country:US
Mailing Address - Phone:209-577-1055
Mailing Address - Fax:
Practice Address - Street 1:2030 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3785
Practice Address - Country:US
Practice Address - Phone:209-577-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2016-03-02
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
CA55-5118OtherMEDICARE ID-TYPE UNSPECIFIED