Provider Demographics
NPI:1952465791
Name:APPLEWOOD OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:APPLEWOOD OPERATING COMPANY, LLC
Other - Org Name:COPPER RIDGE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:201 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1843
Mailing Address - Country:US
Mailing Address - Phone:530-222-2273
Mailing Address - Fax:530-222-5159
Practice Address - Street 1:201 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1843
Practice Address - Country:US
Practice Address - Phone:530-222-2273
Practice Address - Fax:530-222-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952465791Medicaid
CA1952465791Medicaid