Provider Demographics
NPI:1629724067
Name:PACIFIC CARE SALIDA
Entity type:Organization
Organization Name:PACIFIC CARE SALIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GURMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-222-3727
Mailing Address - Street 1:PO BOX 4730
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5404 KIERNAN AVE
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9130
Practice Address - Country:US
Practice Address - Phone:646-416-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility