MEDICARE: DYCORA TRANSITIONAL HEALTH - WEBER OAKS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA

General Provider Information

NPI Number	:	1295278067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYCORA TRANSITIONAL HEALTH - WEBER OAKS LLC

Provider Business Mailing Address
First Line	:	2740 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5529
Country	:	US
Telephone Number	:	209-466-3522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5529
Country	:	US
Telephone Number	:	209-466-3522
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	MARY HAWKINS
Credential	:
Telephone Number	:	209-466-3522

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	01/24/2018

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