GARY GREEN
Intermediate Care Facility, Mentally Retarded
Chico, California
Provider NPI: 1134193600
Organization Information:Organization Name: GARY GREEN
Practice Location:
13961 KELSEY DR CHICO, CA 95973 US
Tel: 530-226-0375 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
13961 KELSEY DR CHICO, CA 95973 US
Tel: 530-226-0375 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | CA | 230000203 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
LTC60997F | CA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin