Provider Demographics
NPI:1609899046
Name:THEKKEK HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:THEKKEK HEALTH SERVICES INC.
Other - Org Name:MARTINEZ CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREMA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEKKEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-449-3400
Mailing Address - Street 1:4110 ALHAMBRA WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3924
Mailing Address - Country:US
Mailing Address - Phone:925-228-4260
Mailing Address - Fax:925-228-9186
Practice Address - Street 1:4110 ALHAMBRA WAY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3924
Practice Address - Country:US
Practice Address - Phone:925-228-4260
Practice Address - Fax:925-228-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44192219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR18527GMedicaid
CAZZR18527GMedicaid
CA5377780001Medicare NSC
CA555821Medicare Oscar/Certification