Provider Demographics
NPI:1609876234
Name:UNIVERSITY RETIREMENT COMMUNITY AT DAVIS INC
Entity Type:Organization
Organization Name:UNIVERSITY RETIREMENT COMMUNITY AT DAVIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-857-7212
Mailing Address - Street 1:1515 SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6691
Mailing Address - Country:US
Mailing Address - Phone:530-747-7000
Mailing Address - Fax:530-747-6255
Practice Address - Street 1:1515 SHASTA DR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6691
Practice Address - Country:US
Practice Address - Phone:530-747-7000
Practice Address - Fax:530-747-6255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC RETIREMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000703314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555769Medicare Oscar/Certification