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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