Provider Demographics
NPI:1801409479
Name:NOV MODESTO LLC
Entity Type:Organization
Organization Name:NOV MODESTO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-953-0476
Mailing Address - Street 1:7501 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3059
Mailing Address - Country:US
Mailing Address - Phone:916-486-9639
Mailing Address - Fax:916-750-5701
Practice Address - Street 1:1248 NELSON AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5360
Practice Address - Country:US
Practice Address - Phone:209-527-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLW MODESTO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility