Healthcare Provider Details

I. General information

NPI: 1750687687
Provider Name (Legal Business Name): DHK MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 AUGUSTUS CT
STOCKTON CA
95207-6632
US

IV. Provider business mailing address

PO BOX 690662
STOCKTON CA
95269-0662
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-9833
  • Fax: 209-477-9933
Mailing address:
  • Phone: 209-478-9833
  • Fax: 209-477-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DARRELL J. GAPASIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 209-481-8287