Provider Demographics
NPI:1306838438
Name:THE REUTLINGER COMMUNITY
Entity type:Organization
Organization Name:THE REUTLINGER COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-334-0810
Mailing Address - Street 1:5105 MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0523
Mailing Address - Country:US
Mailing Address - Phone:916-334-0810
Mailing Address - Fax:916-338-1248
Practice Address - Street 1:4000 CAMINO TASSAJARA
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4711
Practice Address - Country:US
Practice Address - Phone:925-648-2800
Practice Address - Fax:925-648-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X, 314000000X
CA140000589332BN1400X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306838438Medicaid
CA05-5534Medicare ID - Type Unspecified
CA4196580001Medicare NSC