Healthcare Provider Details

I. General information

NPI: 1427520998
Provider Name (Legal Business Name): CENTRAL VALLEY SPECIALTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
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

730 17TH ST
MODESTO CA
95354-1209
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 3
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