Provider Demographics
NPI:1306643168
Name:VETERANS HOME OF CALIFORNIA
Entity type:Organization
Organization Name:VETERANS HOME OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SNF ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:SF
Authorized Official - Last Name:CADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-944-4520
Mailing Address - Street 1:100 CALIFORNIA DRIVE, 3E, ROOM 13
Mailing Address - Street 2:
Mailing Address - City:YOUNTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94599-1412
Mailing Address - Country:US
Mailing Address - Phone:707-944-4506
Mailing Address - Fax:707-944-5052
Practice Address - Street 1:100 CALIFORNIA DRIVE
Practice Address - Street 2:
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1412
Practice Address - Country:US
Practice Address - Phone:707-944-4506
Practice Address - Fax:707-944-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty