Healthcare Provider Details

I. General information

NPI: 1144221896
Provider Name (Legal Business Name): BECHTHOLD CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S FAIRMONT AVE
LODI CA
95240-3835
US

IV. Provider business mailing address

610 S FAIRMONT AVE
LODI CA
95240-3835
US

V. Phone/Fax

Practice location:
  • Phone: 209-367-7400
  • Fax: 209-368-4491
Mailing address:
  • Phone: 209-367-7400
  • Fax: 209-368-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000014
License Number StateCA

VIII. Authorized Official

Name: MR. TERRY BANE
Title or Position: CHIEF OPERATING OFFICIER
Credential:
Phone: 530-897-5100