Provider Demographics
NPI:1326032327
Name:VALLEY SUBACUTE & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:VALLEY SUBACUTE & REHABILITATION CENTER, LLC
Other - Org Name:CENTRAL VALLEY POST ACUTE, MODESTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-248-7851
Mailing Address - Street 1:700 17TH ST
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1247
Mailing Address - Country:US
Mailing Address - Phone:209-248-7851
Mailing Address - Fax:209-248-7856
Practice Address - Street 1:515 E ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5510
Practice Address - Country:US
Practice Address - Phone:209-529-0516
Practice Address - Fax:209-521-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CA100000127314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05869HMedicaid
CAZZR05869HMedicaid