# COVENANT CARE CALIFORNIA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vintage Faire Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487641361
- **Authorized official:** SUSAN P MORGAN (ADMINISTRATOR)
- **Authorized official phone:** (209) 521-2094

## Contact information

- **Practice address:** 3620B DALE RD, MODESTO, CA 95356-0500
- **Practice address phone:** (209) 521-2094
- **Practice address fax:** (209) 521-6180
- **Mailing address:** 3620B DALE RD, MODESTO, CA 95356-0500
- **Mailing address phone:** (209) 521-2094
- **Mailing address fax:** (209) 521-6180

## Taxonomy

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

## Other

- **Enumeration date:** 10/05/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 55355H | — | CA |