Healthcare Provider Details

I. General information

NPI: 1245288521
Provider Name (Legal Business Name): LONG TERM CARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 N LINCOLN ST
STOCKTON CA
95203-2409
US

IV. Provider business mailing address

5600 SPRING MOUNTAIN RD SUITE # 207
LAS VEGAS NV
89146-8821
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-5341
  • Fax: 209-466-5355
Mailing address:
  • Phone: 702-893-8962
  • 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: STEVEN R. PAVLOW
Title or Position: PRESIDENT
Credential:
Phone: 702-893-8962