Provider Demographics
NPI:1083899660
Name:COUNTRY PALMS CARE HOME
Entity Type:Organization
Organization Name:COUNTRY PALMS CARE HOME
Other - Org Name:JOSEPH J TRIPLETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-462-1135
Mailing Address - Street 1:2905 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3935
Mailing Address - Country:US
Mailing Address - Phone:209-462-1135
Mailing Address - Fax:209-462-0335
Practice Address - Street 1:2905 BRISTOL AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3935
Practice Address - Country:US
Practice Address - Phone:209-462-1135
Practice Address - Fax:209-462-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397002983310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility