Healthcare Provider Details

I. General information

NPI: 1902788706
Provider Name (Legal Business Name): STANISLAUS SUBACUTE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 OAKDALE RD
MODESTO CA
95355-3356
US

IV. Provider business mailing address

PO BOX 4730
MODESTO CA
95352-4730
US

V. Phone/Fax

Practice location:
  • Phone: 209-901-4212
  • Fax: 209-901-4218
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: MARIA MUNOZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-901-4212