Provider Demographics
NPI:1235546300
Name:VALLEY CAREIDENCE OPCO, LLC
Entity Type:Organization
Organization Name:VALLEY CAREIDENCE OPCO, LLC
Other - Org Name:GATEWAY POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:140 N UNION AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2956
Mailing Address - Country:US
Mailing Address - Phone:801-447-9829
Mailing Address - Fax:
Practice Address - Street 1:661 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5926
Practice Address - Country:US
Practice Address - Phone:559-784-5900
Practice Address - Fax:559-784-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000567314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18820GMedicaid
CAZZT18820GMedicaid