Healthcare Provider Details

I. General information

NPI: 1326032327
Provider Name (Legal Business Name): VALLEY SUBACUTE & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ORANGEBURG AVE
MODESTO CA
95350-5510
US

IV. Provider business mailing address

700 17TH ST SUITE 201C
MODESTO CA
95354-1247
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-0516
  • Fax: 209-521-7069
Mailing address:
  • Phone: 209-248-7851
  • Fax: 209-248-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000127
License Number StateCA

VIII. Authorized Official

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