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General NPI Number Information
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NPI Number | 1487476024
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Entity Type | Organization
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Legal Business Name | BRODY BAY HEALTHCARE, INC.
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 900 N CHURCH ST
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City | LODI
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State | CA
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Zip | 95240-1282
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Country | US
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Telephone | 209-333-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N CHURCH ST
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City | LODI
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State | CA
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Zip | 95240-1282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | SOON BURNAM
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Credential |
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Telephone | 949-540-1249
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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 |
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License Number State |
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