Provider Demographics
NPI:1366548356
Name:RAYCOTT HEALTHCARE MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:RAYCOTT HEALTHCARE MANAGEMENT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-525-6621
Mailing Address - Street 1:220 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3247
Mailing Address - Country:US
Mailing Address - Phone:805-525-6621
Mailing Address - Fax:805-933-9182
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3247
Practice Address - Country:US
Practice Address - Phone:805-525-6621
Practice Address - Fax:805-933-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05603KMedicaid
NE055603Medicare ID - Type UnspecifiedMUTUAL OF OMAHA