MEDICARE: VALLEY POINTE NURSING AND REHABILITATION CENTER, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	020000016	CA
2	332BN1400X	Nursing Facility Supplies (DME)	020000016	CA
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	020000016	CA
4	314000000X	Skilled Nursing Facility	020000016	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1189870004	OTHER	CA	CIGNA

NPI Number	:	1053303172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY POINTE NURSING AND REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	5000 EXECUTIVE PKWY
Second Line	:	SUITE 150
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4210
Country	:	US
Telephone Number	:	925-855-0881
Fax Number	:	925-855-9297

Provider Business Practice Location Address
First Line	:	20090 STANTON AVE
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5203
Country	:	US
Telephone Number	:	510-538-8464
Fax Number	:	510-538-3233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES PREIMESBERGER
Credential	:
Telephone Number	:	925-855-0881

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/13/2014

200 COTTAGE AVE , STE 101
MANTECA, CA
95336-4935

Practice Phone: 209-239-2197
Practice Fax: 209-239-7672