1952534927 NPI number — GERIATRICS LONG TERM CARE MEDICAL CORPORATION

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 1952534927 NPI number — GERIATRICS LONG TERM CARE MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRICS LONG TERM CARE MEDICAL CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1952534927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95267-0304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-659-3509
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 ROBINHOOD DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-475-8144
Provider Business Practice Location Address Fax Number:
209-474-7679
Provider Enumeration Date:
08/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
BAO
Authorized Official Middle Name:
QUY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-659-3707

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A927250 , 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: A927250 . This is a "PHYSICIAN AND SURGEON LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A927250 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com