Organization
DEGROOT NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADRIAANTJE SJANY DE GROOT RN (ADMINISTRATOR)
(805) 543-7663
Entity
Organization
Contact information
Practice address
1015 BUCHON ST, SAN LUIS OBISPO, CA 93401-4021
(805) 543-7663
(805) 544-7967
Mailing address
1015 BUCHON ST, SAN LUIS OBISPO, CA 93401-4021
(805) 543-7663
(805) 544-7967
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC80007F
MEDI-CAL ID NUMBER
CA
Enumeration date
01/30/2007
Last updated
08/22/2020
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