Healthcare Provider Details

I. General information

NPI: 1427110055
Provider Name (Legal Business Name): SKY PARK HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 SCENIC DR
MODESTO CA
95355-4907
US

IV. Provider business mailing address

1611 SCENIC DR
MODESTO CA
95355-4907
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-5667
  • Fax: 209-523-6529
Mailing address:
  • Phone: 209-523-5667
  • Fax: 209-523-6529

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: TERESA J PALLIVATHUCAL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 209-523-5667