# REDWOD SHORE EMPIRE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Redwood Empire Nursing & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710165162
- **Authorized official:** MRS. THRESIAMMA J PALLIVATHUCAL RN (OWNER)
- **Authorized official phone:** (209) 576-5725

## Contact information

- **Practice address:** 131 WHITMORE LN, UKIAH, CA 95482-6931
- **Practice address phone:** (209) 576-5725
- **Mailing address:** 3141 ELYSE CT, MODESTO, CA 95355-8692
- **Mailing address phone:** (209) 576-5725

## Taxonomy

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

## Other

- **Enumeration date:** 02/07/2008
- **Last updated:** 02/07/2008