# ROOSEVELT LAKE HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sierra Vista Post-Acute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134003411
- **Authorized official:** TOBY TILFORD (CEO)
- **Authorized official phone:** (858) 774-8342

## Contact information

- **Practice address:** 1900 COFFEE RD, MODESTO, CA 95355-2703
- **Practice address phone:** (209) 526-1775
- **Mailing address:** 16544 FRANZEN FARM RD, SAN DIEGO, CA 92127-2240
- **Mailing address phone:** (858) 798-5700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/01/2025
- **Last updated:** 08/01/2025