Wagner Heights Residential

LBN: Covenant Care California, Llc
Wagner Heights Residential is an health care organization with primary practice located at 2435 Wagner Heights Rd , Stockton CA 95209-1778. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as the primary health care specialty. Covenant Care California, Llc can be contacted via phone (209) 477-5353, or through Sparks, Carol via phone (949) 349-1200.

Contact Information

Primary practice address
2435 Wagner Heights Rd Stockton CA 95209-1778
Phone: (209) 477-5353
Fax: (209) 477-9959
Website:
Map and Directions
Authorized official contact:
Name: Sparks, Carol
Phone: (949) 349-1200

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 397000308 California

Profile Details

NPI number 1639205925
LBN Legal business name Covenant Care California, Llc
DBA Doing business as Wagner Heights Residential
Authorized official Sparks, Carol
Entity Organization
Organization subpart 1 No
Enumeration date Feb 23rd, 2007
Last updated Mar 16th, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639205925 NPPES
California MEDICAID RCF00025F

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