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General NPI Number Information
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NPI Number | 1730596214
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Entity Type | Organization
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Legal Business Name | SOLIDUM CARE HOME ICF/DD-N #3
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 8712 ENSENADA DR
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City | STOCKTON
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State | CA
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Zip | 95210-1213
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Country | US
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Telephone | 209-476-0541
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Fax |
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Provider Business Mailing Address
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Address Line | 9559 COLINGTON PL
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City | STOCKTON
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State | CA
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Zip | 95209-5013
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Country | US
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Telephone | 209-474-6785
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Fax |
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | NORMA SOLIDUM
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Credential |
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Telephone | 209-474-6785
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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 | CA
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