Healthcare Provider Details

I. General information

NPI: 1184321036
Provider Name (Legal Business Name): EASTWOOD CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 EASTWOOD AVE
MANTECA CA
95336-3167
US

IV. Provider business mailing address

410 EASTWOOD AVE
MANTECA CA
95336-3167
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-1222
  • Fax:
Mailing address:
  • Phone: 209-239-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEKUTTY JOSE
Title or Position: CEO
Credential:
Phone: 925-999-0004