Provider Demographics
NPI:1548959752
Name:SHILOH GREEN HOMES LLC
Entity type:Organization
Organization Name:SHILOH GREEN HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:707-837-5761
Mailing Address - Street 1:1182 VINTAGE GREENS DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-6864
Mailing Address - Country:US
Mailing Address - Phone:707-837-5761
Mailing Address - Fax:707-687-5063
Practice Address - Street 1:1182 VINTAGE GREENS DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6864
Practice Address - Country:US
Practice Address - Phone:707-837-5761
Practice Address - Fax:707-687-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility