Healthcare Provider Details

I. General information

NPI: 1124663034
Provider Name (Legal Business Name): HAMOA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ORANGEBURG AVE
MODESTO CA
95350-5510
US

IV. Provider business mailing address

20400 SARATOGA LOS GATOS RD
SARATOGA CA
95070-5927
US

V. Phone/Fax

Practice location:
  • Phone: 209-480-7891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-945-1248