Provider Demographics
NPI:1386621357
Name:EUREKA HEALTHCARE AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:EUREKA HEALTHCARE AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-445-3261
Mailing Address - Street 1:2353 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3201
Mailing Address - Country:US
Mailing Address - Phone:707-445-3261
Mailing Address - Fax:707-441-8449
Practice Address - Street 1:2353 23RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3201
Practice Address - Country:US
Practice Address - Phone:707-445-3261
Practice Address - Fax:707-441-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01000054314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC05003KMedicaid
CA055003Medicare Oscar/Certification