Provider Demographics
NPI:1023673258
Name:ESKATON
Entity type:Organization
Organization Name:ESKATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-459-3220
Mailing Address - Street 1:1640 ESKATON LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5185
Mailing Address - Country:US
Mailing Address - Phone:916-459-3220
Mailing Address - Fax:916-331-2986
Practice Address - Street 1:1640 ESKATON LOOP
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5185
Practice Address - Country:US
Practice Address - Phone:916-459-3220
Practice Address - Fax:916-331-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA314700008OtherHCSB