Healthcare Provider Details

I. General information

NPI: 1376315259
Provider Name (Legal Business Name): ORCHARD GRIDLEY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SPRUCE ST
GRIDLEY CA
95948-2216
US

IV. Provider business mailing address

700 17TH ST STE 205
MODESTO CA
95354-1249
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-9000
  • Fax:
Mailing address:
  • Phone: 209-287-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: TAMMY THOMPSON
Title or Position: CFO/VP FINANCE
Credential:
Phone: 209-287-6308