Provider Demographics
NPI:1518008101
Name:SPRING HILL MANOR CONVALESCENT AND REHABILITATION HOSPITAL, INC.
Entity Type:Organization
Organization Name:SPRING HILL MANOR CONVALESCENT AND REHABILITATION HOSPITAL, INC.
Other - Org Name:SPRING HILL MANOR CONVALESCENT HOSPITAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:VIXIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-446-6503
Mailing Address - Street 1:355 JOERSCHKE DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5288
Mailing Address - Country:US
Mailing Address - Phone:530-273-7247
Mailing Address - Fax:530-273-8961
Practice Address - Street 1:355 JOERSCHKE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5288
Practice Address - Country:US
Practice Address - Phone:530-273-7247
Practice Address - Fax:530-274-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000131314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05640FMedicaid
CAZZR05640FMedicaid