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Organization
KAISER FOUNDATION HOSPITALS
Active
Organization
KAISER FOUNDATION HOSPITALS
Active
Other names
KAISER FOUNDATION HOSPITAL-MANTECA DPSNF
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH FRIBERG (SR. VP/AREA MANAGER)
(209) 735-4146
Entity
Organization
Contact information
Practice address
1777 W YOSEMITE AVE, MANTECA, CA 95337-5130
(209) 825-3625
(209) 825-3627
Mailing address
1777 W YOSEMITE AVE, MANTECA, CA 95337-5130
(209) 825-3625
(209) 825-3627
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
030000393
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0093734
—
CA
05
—
LTC55601H
—
CA
05
—
LTC70075H
—
CA
Enumeration date
11/21/2006
Last updated
04/22/2021
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