Provider Demographics
NPI:1679509228
Name:NORTHSHORE INVESTMENTS, INC.
Entity Type:Organization
Organization Name:NORTHSHORE INVESTMENTS, INC.
Other - Org Name:CRESCENT CITY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINLIC#NHA5276
Authorized Official - Phone:707-464-6151
Mailing Address - Street 1:1280 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2217
Mailing Address - Country:US
Mailing Address - Phone:707-464-6151
Mailing Address - Fax:707-464-6064
Practice Address - Street 1:1280 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2217
Practice Address - Country:US
Practice Address - Phone:707-464-6151
Practice Address - Fax:707-464-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06296LMedicaid
CAMTN00826FMedicaid
CAZZR06296LMedicaid