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Organization
COVENANT CARE CALIFORNIA, LLC
Active
Organization
COVENANT CARE CALIFORNIA, LLC
Active
Other names
Vintage Faire Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SPARKS (DIRECTOR OF REIMBURSEMENT)
(949) 349-1200
Entity
Organization
Contact information
Practice address
3620 DALE RD, SUITE B, MODESTO, CA 95356-0598
(209) 521-2094
(209) 521-6180
Mailing address
120 VANTIS DR STE 200, ALISO VIEJO, CA 92656-2677
(949) 349-1200
(949) 349-1122
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100000366
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206504004
OSHPD
CA
05
—
LTC55355H
—
CA
Enumeration date
02/13/2007
Last updated
08/14/2026
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