Healthcare Provider Details

I. General information

NPI: 1851392500
Provider Name (Legal Business Name): DELTA SKILLED NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 S HAM LN
LODI CA
95242-3903
US

IV. Provider business mailing address

1334 S HAM LN
LODI CA
95242-3903
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-3825
  • Fax: 209-368-7714
Mailing address:
  • Phone: 209-334-3825
  • Fax: 209-368-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000138
License Number StateCA

VIII. Authorized Official

Name: MR. TERRY BANE
Title or Position: PRESIDENT
Credential:
Phone: 530-897-5100