Provider Demographics
NPI:1568616480
Name:VETERANS HOME OF CALIFORNIA
Entity Type:Organization
Organization Name:VETERANS HOME OF CALIFORNIA
Other - Org Name:N.M. HOLDERMAN MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPS
Authorized Official - Phone:707-944-4501
Mailing Address - Street 1:PO BOX 942895
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:94295-0001
Mailing Address - Country:US
Mailing Address - Phone:916-653-0080
Mailing Address - Fax:916-653-1795
Practice Address - Street 1:100 CALIFORNIA DR
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1411
Practice Address - Country:US
Practice Address - Phone:707-944-4716
Practice Address - Fax:707-944-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15000494286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA1272OtherRAILROAD MEDICARE
CA555095Medicare Oscar/Certification
CA050667Medicare Oscar/Certification
CAZZZ96688ZMedicare PIN