Provider Demographics
NPI:1891847364
Name:CF QUINCY, LLC
Entity Type:Organization
Organization Name:CF QUINCY, LLC
Other - Org Name:QUINCY HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-651-1808
Mailing Address - Street 1:50 EAST CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-283-2110
Mailing Address - Fax:530-283-2274
Practice Address - Street 1:50 EAST CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971
Practice Address - Country:US
Practice Address - Phone:530-283-2110
Practice Address - Fax:530-283-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2014-07-21
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-04-18
Provider Licenses
StateLicense IDTaxonomies
CA230000050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06265JMedicaid
CA056265Medicare Oscar/Certification