MEDICARE: FOUR SD CONSTRUCTION

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1518816370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SD CONSTRUCTION

Provider Business Mailing Address
First Line	:	PO BOX 1455
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91979-1455
Country	:	US
Telephone Number	:	619-929-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 PARAISO AVE
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-6030
Country	:	US
Telephone Number	:	619-929-1048
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PANKEY
Credential	:
Telephone Number	:	619-248-2920

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “FOUR SD CONSTRUCTION ” Practice Location

Language	Start Address	Practice Location

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