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Organization
ENSIGN CLOVERDALE LLC
Active
Organization
ENSIGN CLOVERDALE LLC
Active
Other names
Cloverdale Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SOON BURNAM (AUTHORIZED AGENT)
(949) 540-1249
Entity
Organization
Contact information
Practice address
300 CHERRY CREEK ROAD, CLOVERDALE, CA 95425-3811
(707) 894-5201
(707) 894-9324
Mailing address
300 CHERRY CREEK ROAD, CLOVERDALE, CA 95425-3811
(707) 894-5201
(707) 894-9324
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
010000157
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05756I
—
CA
Enumeration date
09/16/2005
Last updated
02/17/2021
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