Provider Demographics
NPI:1659596856
Name:CASA DEL RIOS
Entity Type:Organization
Organization Name:CASA DEL RIOS
Other - Org Name:SOLARI RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-931-1027
Mailing Address - Street 1:5541 SOLARI RANCH RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-9318
Mailing Address - Country:US
Mailing Address - Phone:209-931-1027
Mailing Address - Fax:209-931-5516
Practice Address - Street 1:5541 SOLARI RANCH RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-9318
Practice Address - Country:US
Practice Address - Phone:209-931-1027
Practice Address - Fax:209-931-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03000587313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80169FMedicaid
CA03000587OtherSTATE LICENSE