Provider Demographics
NPI:1780665356
Name:GERI-CARE V, LLC
Entity Type:Organization
Organization Name:GERI-CARE V, LLC
Other - Org Name:WELLSPRINGS POST ACUTE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:661-948-7501
Mailing Address - Street 1:44445 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2801
Mailing Address - Country:US
Mailing Address - Phone:661-948-7501
Mailing Address - Fax:661-949-5498
Practice Address - Street 1:44445 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2801
Practice Address - Country:US
Practice Address - Phone:661-948-7501
Practice Address - Fax:661-949-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06039Medicaid
CA056039Medicare Oscar/Certification