Provider Demographics
NPI:1912086976
Name:MARYSVILLE NURSING & REHAB LLC
Entity Type:Organization
Organization Name:MARYSVILLE NURSING & REHAB LLC
Other - Org Name:MARYSVILLE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-742-7311
Mailing Address - Street 1:1617 RAMIREZ ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-4334
Mailing Address - Country:US
Mailing Address - Phone:530-742-7311
Mailing Address - Fax:530-742-2356
Practice Address - Street 1:1617 RAMIREZ ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-4334
Practice Address - Country:US
Practice Address - Phone:530-742-7311
Practice Address - Fax:530-742-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55682GMedicaid
CALTC55682GMedicaid