Healthcare Provider Details

I. General information

NPI: 1497820021
Provider Name (Legal Business Name): MERIDIAN HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PARK ST
WEED CA
96094-2332
US

IV. Provider business mailing address

5000 EXECUTIVE PKWY SUITE 150
SAN RAMON CA
94583-4210
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-4429
  • Fax:
Mailing address:
  • Phone: 925-855-0881
  • Fax: 925-855-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000042
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES R PREIMESBERGER
Title or Position: PRESIDENT
Credential:
Phone: 213-709-4887