Healthcare Provider Details

I. General information

NPI: 1578989703
Provider Name (Legal Business Name): CENTRAL VALLEY SPECIALTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
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: 209-248-7710
  • Fax: 209-846-0345
Mailing address:
  • Phone: 209-248-7710
  • Fax: 209-846-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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