Provider Demographics
NPI:1477552164
Name:UNITED COM-SERVE
Entity Type:Organization
Organization Name:UNITED COM-SERVE
Other - Org Name:THE FOUNTAINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-790-3002
Mailing Address - Street 1:1260 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2400
Mailing Address - Country:US
Mailing Address - Phone:530-790-3000
Mailing Address - Fax:530-751-4894
Practice Address - Street 1:1260 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2400
Practice Address - Country:US
Practice Address - Phone:530-790-3000
Practice Address - Fax:530-751-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000176314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD08602586OtherMED PT B CIGNA DME
CALTC55430FMedicaid
CAD08602586OtherMED PT B CIGNA DME