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General NPI Number Information
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NPI Number | 1750687687
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Entity Type | Organization
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Legal Business Name | DHK MANOR, INC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 4513 AUGUSTUS CT
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City | STOCKTON
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State | CA
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Zip | 95207-6632
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Country | US
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Telephone | 209-478-9833
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Fax | 209-477-9933
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Provider Business Mailing Address
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Address Line | PO BOX 690662
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City | STOCKTON
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State | CA
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Zip | 95269-0662
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Country | US
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Telephone | 209-478-9833
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Fax | 209-477-9933
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DARRELL J. GAPASIN
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Credential |
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Telephone | 209-481-8287
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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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