Basic Information
| Provider Information | |||||||||
| NPI: | 1578989703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VALLEY SPECIALTY HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 17TH ST | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953541209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092487710 | ||||||||
| FaxNumber: | 2098460345 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 17TH ST | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953541209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092487710 | ||||||||
| FaxNumber: | 2098460345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2092487851 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | N | Hospitals | Long Term Care Hospital | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.