Healthcare Provider Details

I. General information

NPI: 1992128904
Provider Name (Legal Business Name): CONSONUS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S HAM LN
LODI CA
95242-3543
US

IV. Provider business mailing address

800 S HAM LN
LODI CA
95242-3543
US

V. Phone/Fax

Practice location:
  • Phone: 209-368-7141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2014
License Number StateCA

VIII. Authorized Official

Name: ANNA BROWN
Title or Position: HR SPECIALIST
Credential:
Phone: 971-206-5102