Healthcare Provider Details

I. General information

NPI: 1134470156
Provider Name (Legal Business Name): CENTRAL VALLEY SPECIALTY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

1320 STANDIFORD AVE SUITE 4 PMB 214
MODESTO CA
95350-0726
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-2532
  • Fax: 209-576-2598
Mailing address:
  • Phone: 209-576-2532
  • Fax: 209-576-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: TAMMY JEAN THOMPSON
Title or Position: VP FINANCE
Credential:
Phone: 209-248-7851