Provider Demographics
NPI:1154396919
Name:REDWOOD SENIOR HOMES AND SERVICES
Entity type:Organization
Organization Name:REDWOOD SENIOR HOMES AND SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-0420
Mailing Address - Street 1:516 BURCHETT STREET
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1014
Mailing Address - Country:US
Mailing Address - Phone:818-247-0420
Mailing Address - Fax:818-247-3871
Practice Address - Street 1:710 W 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5511
Practice Address - Country:US
Practice Address - Phone:760-747-4306
Practice Address - Fax:760-480-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000145314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55146GMedicaid
CA555146Medicare Oscar/Certification