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VINTAGE FAIRE NURSING & REHABILITATION CENTER
NPI 1437291929
Skilled Nursing Facility in Modesto, CA

Active since February 13, 2007CLIA 05D0883490 · Waiver
3620 DALE RD, SUITE B, MODESTO, CA 95356(209) 521-2094(209) 521-6180 Get Directions Write a Review

NPPES record last updated: February 3, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Vintage Faire Nursing & Rehabilitation Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VINTAGE FAIRE NURSING & REHABILITATION CENTER (NPI 1437291929) is a healthcare organization registered as a skilled nursing facility in Modesto, California and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through March 7, 2028 and lists Carol Sparks, Director Of Reimbursement, as its authorized official.

NPPES Registry Identity

NPI1437291929
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCOVENANT CARE CALIFORNIA, LLC
Location Address3620 DALE RD, SUITE BModesto, CA 95356-0598
Mailing Address3620 Dale Rd, Suite BModesto, CA 95356-0598 · (209) 521-2094 · Fax (209) 521-6180
Phone(209) 521-2094
Fax(209) 521-6180
Organization SubpartNo
Authorized OfficialCarol SparksDirector Of Reimbursement · (949) 349-1200
Enumeration DateFebruary 13, 2007
Last NPPES UpdateFebruary 3, 2014
✔ NPI 1437291929 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in CA · 100000366
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
3620 DALE RD, Modesto, CA 95356
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Other Names 1

Doing Business AsVintage Faire Nursing & Rehabilitation Center

Other Identifiers 3

MedicaidLTC55355HCA
Medicare OSCAR/certification555355CA
Other206504004CA · Oshpd

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0883490

Vintage Faire Nursing And Rehabilitation Center · Modesto, CA
Active · expires Mar 7, 2028
CLIA Number05D0883490
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateMarch 8, 2026
Certificate Expiration DateMarch 7, 2028
Laboratory DirectorAlexander Chan MD
Laboratory Phone(209) 521-2094
Laboratory LocationVintage Faire Nursing And Rehabilitation Center3620-B Dale Road, Modesto, CA 95356
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL HASKELL
Occupational Therapist
3620 DALE RD
MODESTO, CA 95356
Stanislaus County (209) 521-2094
RENEE GAY AQUINO
Physical Therapy Assistant
3620 DALE RD
MODESTO, CA 95356
Stanislaus County (209) 521-2094

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Covenant Care California, LLC's NPI number?

The NPI number for Covenant Care California, LLC is 1437291929. It was assigned to this organization in the NPPES registry on February 13, 2007. The provider is doing business as Vintage Faire Nursing & Rehabilitation Center.

Where is Covenant Care California, LLC located?

Covenant Care California, LLC is located at 3620 Dale Rd Suite B, Modesto, CA 95356. The listed phone number is (209) 521-2094.

What is Covenant Care California, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Covenant Care California, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0883490) is associated with this NPI, valid through March 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Covenant Care California, LLC was last updated on February 3, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.