Provider Demographics
NPI:1639503972
Name:WHITE FIR HOLDINGS LLC
Entity Type:Organization
Organization Name:WHITE FIR HOLDINGS LLC
Other - Org Name:MID-TOWN OAKS POST-ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:2600 L ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5612
Mailing Address - Country:US
Mailing Address - Phone:916-321-9440
Mailing Address - Fax:916-321-9455
Practice Address - Street 1:2600 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5612
Practice Address - Country:US
Practice Address - Phone:916-321-9440
Practice Address - Fax:916-321-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639503972Medicaid
CA1639503972Medicaid