Healthcare Provider Details

I. General information

NPI: 1255336533
Provider Name (Legal Business Name): STOCKTON CONGREGATIONAL HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 N MADISON ST
STOCKTON CA
95202-1047
US

IV. Provider business mailing address

1319 N MADISON ST
STOCKTON CA
95202-1047
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-4341
  • Fax: 209-466-8853
Mailing address:
  • Phone: 209-466-4341
  • Fax: 209-466-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000076
License Number StateCA

VIII. Authorized Official

Name: STUART HARTMAN
Title or Position: V.P. OF OPERATIONS
Credential:
Phone: 562-257-5100