Provider Demographics
NPI:1689710048
Name:WINDSOR SKYLINE CARE CENTER, LLC
Entity Type:Organization
Organization Name:WINDSOR SKYLINE CARE CENTER, LLC
Other - Org Name:WINDSOR SKYLINE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-1090
Mailing Address - Street 1:348 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3514
Mailing Address - Country:US
Mailing Address - Phone:831-499-5496
Mailing Address - Fax:831-757-5049
Practice Address - Street 1:348 IRIS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3514
Practice Address - Country:US
Practice Address - Phone:831-499-5496
Practice Address - Fax:831-757-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
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
CAZZR05871JMedicaid
CAZZR05871JMedicaid