NPIMap

Organization Active NPI

Covenant Living West

Doing business as Brandel Manor

  • Skilled Nursing Facility
  • Turlock, CA
National Provider Identifier
1184021768
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
055635 Issued in CA
Legal business name
COVENANT LIVING WEST
Doing business as
Brandel Manor
Practice address
1801 N Olive Ave
Turlock, CA 95382-2568
Phone
(209) 667-5600
NPI assigned
Nov 26, 2014
Last updated
Jul 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Mrs. Elizabeth A Malzahn
Title
National Director of Healthcare
Phone
(773) 878-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 055635 CA Primary

Addresses

Primary practice location

1801 N Olive Ave
Turlock, CA 95382-2568

Mailing address

5700 Old Orchard Rd
Suite 100
Skokie, IL 60077-1036
Phone (773) 878-4430

Other identifiers 1

IdentifierTypeStateIssuer
1306281688OtherCANPI

Other names 1

  • Brandel Manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brandel Manor6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1801 N Olive Ave
Turlock, CA 95382
Phone (209) 410-7200

NPI Registry JSON

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1184021768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 OLD ORCHARD RD",
            "address_2": "SUITE 100",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771036",
            "telephone_number": "773-878-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 N OLIVE AVE",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822568",
            "telephone_number": "209-667-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT LIVING WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-26",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NATIONAL DIRECTOR OF HEALTHCARE",
        "authorized_official_telephone_number": "773-878-4430",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "055635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306281688",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brandel Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brandel Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Turlock, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.