Provider Demographics
NPI:1609941004
Name:NEW COVENANT CARE OF DINUBA, INC.
Entity Type:Organization
Organization Name:NEW COVENANT CARE OF DINUBA, INC.
Other - Org Name:NEW COVENANT CARE OF DINUBA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE (LARRY)
Authorized Official - Middle Name:
Authorized Official - Last Name:KREH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-937-7400
Mailing Address - Street 1:1730 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2812
Mailing Address - Country:US
Mailing Address - Phone:559-591-3300
Mailing Address - Fax:559-591-0705
Practice Address - Street 1:1730 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2812
Practice Address - Country:US
Practice Address - Phone:559-591-3300
Practice Address - Fax:559-591-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000578314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05448HMedicaid
CA055448Medicare ID - Type UnspecifiedMEDICARE NUMBER