Healthcare Provider Details

I. General information

NPI: 1053311225
Provider Name (Legal Business Name): GROSS CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W TURNER RD
LODI CA
95240-0517
US

IV. Provider business mailing address

321 W TURNER RD
LODI CA
95240-0517
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-3760
  • Fax: 209-334-1071
Mailing address:
  • Phone: 209-334-3760
  • Fax: 209-334-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PAUL G GROSS
Title or Position: ADMINISTRATOR/CEO
Credential: M.A.
Phone: 209-334-3760