Healthcare Provider Details

I. General information

NPI: 1871661967
Provider Name (Legal Business Name): LONE TREE CONVALESCENT HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LONE TREE WAY
ANTIOCH CA
94509-6232
US

IV. Provider business mailing address

4001 LONE TREE WAY
ANTIOCH CA
94509-6232
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-0470
  • Fax: 925-754-9142
Mailing address:
  • Phone: 925-754-0470
  • Fax: 925-754-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140000199
License Number StateCA

VIII. Authorized Official

Name: MRS. PHYLENE SUNGA
Title or Position: ADMINISTRATOR
Credential:
Phone: 925-383-4810