Provider Demographics
NPI:1811984495
Name:SEAVIEW HEALTHCARE AND REHABILITION,LLC
Entity type:Organization
Organization Name:SEAVIEW HEALTHCARE AND REHABILITION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VACULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-5668
Mailing Address - Street 1:6400 PURDUE DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7095
Mailing Address - Country:US
Mailing Address - Phone:707-443-5668
Mailing Address - Fax:707-441-8448
Practice Address - Street 1:6400 PURDUE DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-7095
Practice Address - Country:US
Practice Address - Phone:707-443-5668
Practice Address - Fax:707-441-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10000066314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05208KMedicaid
CA055208Medicare Oscar/Certification