Provider Demographics
NPI:1972865301
Name:ATMC LLC
Entity Type:Organization
Organization Name:ATMC LLC
Other - Org Name:TRACY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-347-7100
Mailing Address - Street 1:28202 CABOT RD
Mailing Address - Street 2:412
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1271
Mailing Address - Country:US
Mailing Address - Phone:949-347-7100
Mailing Address - Fax:949-347-7800
Practice Address - Street 1:545 W BEVERLY PL
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3012
Practice Address - Country:US
Practice Address - Phone:209-835-6034
Practice Address - Fax:209-832-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555080Medicare Oscar/Certification