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Organization
PALM HAVEN NURSING & REHAB LLC
Active
Organization
PALM HAVEN NURSING & REHAB LLC
Active
Other names
St Jude Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH PALLIVATHUCAL (GENERAL MANAGER)
(209) 823-1788
Entity
Organization
Contact information
Practice address
469 E NORTH ST, MANTECA, CA 95336
(209) 823-1788
(209) 823-9809
Mailing address
469 E NORTH ST, MANTECA, CA 95336
(209) 823-1788
(209) 823-9809
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100000071
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05917H
—
CA
Enumeration date
07/19/2006
Last updated
12/22/2015
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