1326032327 NPI number — VALLEY SUBACUTE & REHABILITATION CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326032327 NPI number — VALLEY SUBACUTE & REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY SUBACUTE & REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL VALLEY POST ACUTE, MODESTO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326032327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 17TH ST
Provider Second Line Business Mailing Address:
SUITE 201C
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95354-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-248-7851
Provider Business Mailing Address Fax Number:
209-248-7856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E ORANGEBURG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-5510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-529-0516
Provider Business Practice Location Address Fax Number:
209-521-7069
Provider Enumeration Date:
09/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
209-248-7851

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 100000127 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZR05869H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".