Healthcare Provider Details

I. General information

NPI: 1992809156
Provider Name (Legal Business Name): HCM QUINCY CONVALESCENT HOSP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/16/2007

III. Provider practice location address

50 CENTRAL AVENUE
QUINCY CA
95971-9718
US

IV. Provider business mailing address

50 CENTRAL AVENUE
QUINCY CA
95971-9718
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-2110
  • Fax: 530-283-2110
Mailing address:
  • Phone: 530-283-2110
  • Fax: 530-283-2274

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: HOLLEE A NYBERG
Title or Position: CORPORATE ACCOUNTING MANAGER
Credential:
Phone: 559-707-8737