Healthcare Provider Details

I. General information

NPI: 1033221999
Provider Name (Legal Business Name): YOSEMITE CONVALESCENT HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E ORANGEBURG AVE
MODESTO CA
95350-5334
US

IV. Provider business mailing address

632 E YOSEMITE AVE
MADERA CA
93638-3343
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-2811
  • Fax: 209-526-6193
Mailing address:
  • Phone: 559-673-5149
  • Fax: 559-673-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ARDEN BENNETT
Title or Position: CEO
Credential:
Phone: 559-673-5149