# BECHTHOLD CONVALESCENT HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crescent Court Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144221896
- **Authorized official:** MR. TERRY BANE (CHIEF OPERATING OFFICIER)
- **Authorized official phone:** (530) 897-5100

## Contact information

- **Practice address:** 610 S FAIRMONT AVE, LODI, CA 95240-3835
- **Practice address phone:** (209) 367-7400
- **Practice address fax:** (209) 368-4491
- **Mailing address:** 610 S FAIRMONT AVE, LODI, CA 95240-3835
- **Mailing address phone:** (209) 367-7400
- **Mailing address fax:** (209) 368-4491

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100000014 | CA | Yes |

## Other

- **Enumeration date:** 08/03/2005
- **Last updated:** 10/29/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR55079I | — | CA |