Provider Demographics
NPI:1376859439
Name:PALS ASSISTED LIVING SERVICES
Entity Type:Organization
Organization Name:PALS ASSISTED LIVING SERVICES
Other - Org Name:PALS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER, CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-464-3024
Mailing Address - Street 1:404 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4737
Mailing Address - Country:US
Mailing Address - Phone:209-464-3024
Mailing Address - Fax:209-323-4792
Practice Address - Street 1:404 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4737
Practice Address - Country:US
Practice Address - Phone:209-464-3024
Practice Address - Fax:209-323-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101273277332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies