Healthcare Provider Details

I. General information

NPI: 1437121886
Provider Name (Legal Business Name): STANISLAUS SURGICAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 OAKDALE RD
MODESTO CA
95355-3359
US

IV. Provider business mailing address

1421 OAKDALE RD
MODESTO CA
95355-3359
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-2700
  • Fax: 209-572-0151
Mailing address:
  • Phone: 209-572-2700
  • Fax: 209-572-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0300695
License Number StateCA

VIII. Authorized Official

Name: KRISTINE KASSAHN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA, BSN, RN, PHN
Phone: 209-232-2500