Provider Demographics
NPI:1497073845
Name:THE COMMONS AT WOODBRIDGE, LLC
Entity Type:Organization
Organization Name:THE COMMONS AT WOODBRIDGE, LLC
Other - Org Name:THE COMMONS AT UNION RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:NABER-JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-848-4500
Mailing Address - Street 1:2241 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-8271
Mailing Address - Country:US
Mailing Address - Phone:209-463-9100
Mailing Address - Fax:209-463-9101
Practice Address - Street 1:2241 N UNION RD
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-8271
Practice Address - Country:US
Practice Address - Phone:209-463-9100
Practice Address - Fax:209-463-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397004045310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility