Provider Demographics
NPI:1043257041
Name:LODI MEMORIAL HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:LODI MEMORIAL HOSPITAL ASSOCIATION INC
Other - Org Name:LODI MEMORIAL HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-334-3411
Mailing Address - Street 1:PO BOX 3004
Mailing Address - Street 2:975 S FAIRMONT AVE
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1908
Mailing Address - Country:US
Mailing Address - Phone:209-334-3411
Mailing Address - Fax:209-339-7659
Practice Address - Street 1:800 S LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3635
Practice Address - Country:US
Practice Address - Phone:209-334-3411
Practice Address - Fax:209-339-7659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LODI MEMORIAL HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000269251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70079FMedicaid
CAHHA70079FMedicaid