Organization
COVENANT CARE CALIFORNIA, LLC
Active
Organization
COVENANT CARE CALIFORNIA, LLC
Active
Other names
WAGNER HEIGHTS RESIDENTIAL
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SPARKS (DIRECTOR OF REIMBURSEMENT)
(949) 349-1200
Entity
Organization
Contact information
Practice address
2435 WAGNER HEIGHTS RD, STOCKTON, CA 95209-1778
(209) 477-5353
(209) 477-9959
Mailing address
120 VANTIS DR STE 200, ALISO VIEJO, CA 92656-2677
(949) 349-1222
(949) 349-1122
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
397000308
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RCF00025F
—
CA
Enumeration date
02/23/2007
Last updated
03/16/2022
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