MEDICARE: ORCHARD GRIDLEY HOSPITAL INC

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1538931415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORCHARD GRIDLEY HOSPITAL INC

Provider Business Mailing Address
First Line	:	700 17TH ST STE 205
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95354-1249
Country	:	US
Telephone Number	:	209-287-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 ORO DAM BLVD E STE 8
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6035
Country	:	US
Telephone Number	:	530-353-3332
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE/CFO
Name	:	TAMMY THOMPSON
Credential	:
Telephone Number	:	209-287-6308

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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