Provider Demographics
NPI:1710089255
Name:GOLDEN EMPIRE NURSING & REHAB CENTER LP
Entity Type:Organization
Organization Name:GOLDEN EMPIRE NURSING & REHAB CENTER LP
Other - Org Name:GOLDEN EMPIRE CONVALESCENT HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-273-1316
Mailing Address - Street 1:121 DORSEY DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5201
Mailing Address - Country:US
Mailing Address - Phone:530-273-1316
Mailing Address - Fax:530-273-4809
Practice Address - Street 1:121 DORSEY DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5201
Practice Address - Country:US
Practice Address - Phone:530-273-1316
Practice Address - Fax:530-273-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000135314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06391GMedicaid
CAZZR06391GMedicaid