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General NPI Number Information
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NPI Number | 1144221896
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Entity Type | Organization
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Legal Business Name | BECHTHOLD CONVALESCENT HOSPITAL, INC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 610 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-3835
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Country | US
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Telephone | 209-367-7400
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Fax | 209-368-4491
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Provider Business Mailing Address
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Address Line | 610 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-3835
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Country | US
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Telephone | 209-367-7400
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Fax | 209-368-4491
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICIER
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Name | MR. TERRY BANE
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Credential |
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Telephone | 530-897-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100000014
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License Number State | CA
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