Basic Information
| Provider Information | |||||||||
| NPI: | 1760491625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW COVENANT CARE OF DINUBA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW COVENANT CARE CENTER OF DINUBA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2540 CAMINO DIABLO | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945973950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259377400 | ||||||||
| FaxNumber: | 9259370217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1730 S. COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | DINUBA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 836182812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595913300 | ||||||||
| FaxNumber: | 5595910705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEDLALAK | ||||||||
| AuthorizedOfficialFirstName: | DEWAYNE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY/CFO | ||||||||
| AuthorizedOfficialTelephone: | 5259377400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.