Provider Demographics
NPI:1760491625
Name:NEW COVENANT CARE OF DINUBA INC
Entity Type:Organization
Organization Name:NEW COVENANT CARE OF DINUBA INC
Other - Org Name:NEW COVENANT CARE CENTER OF DINUBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEDLALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:525-937-7400
Mailing Address - Street 1:2540 CAMINO DIABLO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3950
Mailing Address - Country:US
Mailing Address - Phone:925-937-7400
Mailing Address - Fax:925-937-0217
Practice Address - Street 1:1730 S. COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:83618-2812
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:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055448Medicare ID - Type Unspecified