St. John'S Retirement Village, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5703000654 Issued in CA

Legal business name

ST. JOHN'S RETIREMENT VILLAGE, INC.

Practice address

135 Woodland Ave
Woodland, CA 95695-2701

Phone

(530) 662-1290

Fax

(530) 662-0852

NPI assigned

Feb 10, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Therese Brown, MSG

Title

Ceo

Phone

(530) 662-1290

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1114386745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 WOODLAND AVE",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956952701",
            "telephone_number": "530-662-1290",
            "fax_number": "530-662-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 WOODLAND AVE",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956952701",
            "telephone_number": "530-662-1290",
            "fax_number": "530-662-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S RETIREMENT VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "THERESE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-662-1290",
        "authorized_official_credential": "MSG"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "5703000654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTN",
            "identifier": "056138",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891914784",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Manon Spycher
• Sheetal Deep Sran, M.D
• Nina Evelyn Sreshta, MD
• SS&MC
• St John Retirement Village
• Stanford Youth Solutions
• Oliver James Stanton, M.D.
• Katherine Ann Stapleton, R.N.
• Michael P Starkweather, DPM
• Kimberly Dawn Starnes, RN

• Assisted Living Facility in Woodland, CA
• Providers in Woodland, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.