Provider Demographics
NPI:1104316413
Name:WEST SACRAMENTO NURSING AND REHABILITATION CENTER
Entity type:Organization
Organization Name:WEST SACRAMENTO NURSING AND REHABILITATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-572-0085
Mailing Address - Street 1:751 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605
Mailing Address - Country:US
Mailing Address - Phone:916-572-0085
Mailing Address - Fax:916-572-0333
Practice Address - Street 1:751 ELM STREET
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605
Practice Address - Country:US
Practice Address - Phone:530-902-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility