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General NPI Number Information
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NPI Number | 1760658553
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Entity Type | Organization
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Legal Business Name | MID VALLEY HEALTH SERVICES LONG TERM CARE INC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 602 SCENIC DR
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City | MODESTO
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State | CA
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Zip | 95350-6128
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Country | US
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Telephone | 209-552-7600
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Fax | 209-552-7638
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Provider Business Mailing Address
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Address Line | 602 SCENIC DR
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City | MODESTO
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State | CA
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Zip | 95350-6128
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Country | US
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Telephone | 209-552-7600
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Fax | 209-552-7638
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Authorized Official
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Title or Position | COO
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Name | HAROLD STOLL
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Credential |
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Telephone | 209-552-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY49880
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License Number State | CA
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