Provider Demographics
NPI:1578989703
Name:CENTRAL VALLEY SPECIALTY HOSPITAL INC
Entity Type:Organization
Organization Name:CENTRAL VALLEY SPECIALTY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP FINANCE
Authorized Official - Prefix:MRS
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 1:730 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1209
Mailing Address - Country:US
Mailing Address - Phone:209-248-7710
Mailing Address - Fax:209-846-0345
Practice Address - Street 1:730 17TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1209
Practice Address - Country:US
Practice Address - Phone:209-248-7710
Practice Address - Fax:209-846-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052055Medicare Oscar/Certification
CA052055Medicare UPIN