Provider Demographics
NPI:1376201046
Name:THE VINEYARDS AT FOWLER LLC
Entity Type:Organization
Organization Name:THE VINEYARDS AT FOWLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-834-2542
Mailing Address - Street 1:662 ENCINITAS BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6790
Mailing Address - Country:US
Mailing Address - Phone:760-652-6354
Mailing Address - Fax:
Practice Address - Street 1:1306 E SUMNER AVE
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-2627
Practice Address - Country:US
Practice Address - Phone:559-834-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine