Healthcare Provider Details

I. General information

NPI: 1356693451
Provider Name (Legal Business Name): CENTRAL VALLEY SPECIALTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
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

1320 STANDIFORD AVE SUITE 4 PMB 214
MODESTO CA
95350-0726
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7710
  • Fax: 209-846-0345
Mailing address:
  • Phone: 209-576-2532
  • Fax: 209-576-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCA0301202
License Number StateCA
# 2
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