Provider Demographics
NPI:1497820021
Name:MERIDIAN HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:MERIDIAN HEALTH SERVICES CORPORATION
Other - Org Name:SHASTA VIEW NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PREIMESBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-709-4887
Mailing Address - Street 1:5000 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4210
Mailing Address - Country:US
Mailing Address - Phone:925-855-0881
Mailing Address - Fax:925-855-9297
Practice Address - Street 1:445 PARK ST
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-2332
Practice Address - Country:US
Practice Address - Phone:530-938-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000042314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05807GMedicaid
CAZZR05807GMedicaid