Healthcare Provider Details

I. General information

NPI: 1073316774
Provider Name (Legal Business Name): NORTH OLIVE SKILLED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N OLIVE AVE
TURLOCK CA
95382-2568
US

IV. Provider business mailing address

1801 N OLIVE AVE
TURLOCK CA
95382-2568
US

V. Phone/Fax

Practice location:
  • Phone: 619-402-3044
  • Fax:
Mailing address:
  • Phone:
  • 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: RICHARD MARTIN
Title or Position: MANAGER
Credential:
Phone: 619-402-3044