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General NPI Number Information
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NPI Number | 1407660277
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Entity Type | Organization
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Legal Business Name | CENTER ST LLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 505 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4719
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Country | US
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Telephone | 209-612-8194
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Fax |
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Provider Business Mailing Address
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Address Line | 505 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4719
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Country | US
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Telephone | 209-612-8194
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SAIFUDDIN RANIWALA
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Credential |
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Telephone | 209-612-8194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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