MEDICARE: DAMERON HOSPITAL HOME HEALTH

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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1780614032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMERON HOSPITAL HOME HEALTH

Provider Business Mailing Address
First Line	:	420 W ACACIA ST
Second Line	:	SUITE 14
City	:	STOCKTON
State	:	CA
Zip	:	95203-2441
Country	:	US
Telephone Number	:	209-461-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 W ACACIA ST
Second Line	:	SUITE 14
City	:	STOCKTON
State	:	CA
Zip	:	95203-2441
Country	:	US
Telephone Number	:	209-461-3103
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DR. CHRISTOPHER ARISMENDI
Credential	:	M.D.
Telephone Number	:	209-944-5550

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/22/2020

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