Healthcare Provider Details

I. General information

NPI: 1306461801
Provider Name (Legal Business Name): PREMIERCARE SKILLED NURSING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BESSIE AVE
TRACY CA
95376-3417
US

IV. Provider business mailing address

1470 BESSIE AVE
TRACY CA
95376-3417
US

V. Phone/Fax

Practice location:
  • Phone: 209-883-0525
  • Fax:
Mailing address:
  • Phone: 209-883-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUNIL PATEL
Title or Position: OWNER / MD
Credential: MD
Phone: 209-883-0525