Provider Demographics
NPI:1164514287
Name:EMANUEL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:EMANUEL MEDICAL CENTER, INC.
Other - Org Name:BRANDEL MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEAPOLITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-664-5000
Mailing Address - Street 1:PO BOX 819005
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-9005
Mailing Address - Country:US
Mailing Address - Phone:209-667-4200
Mailing Address - Fax:209-664-5007
Practice Address - Street 1:1801 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2568
Practice Address - Country:US
Practice Address - Phone:209-667-4200
Practice Address - Fax:209-664-5007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMANUEL MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000035314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05635GMedicaid
CAZZR05635GMedicaid