# PALM HAVEN NURSING & REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Jude Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629097761
- **Authorized official:** JOSEPH PALLIVATHUCAL (GENERAL MANAGER)
- **Authorized official phone:** (209) 823-1788

## Contact information

- **Practice address:** 469 E NORTH ST, MANTECA, CA 95336
- **Practice address phone:** (209) 823-1788
- **Practice address fax:** (209) 823-9809
- **Mailing address:** 469 E NORTH ST, MANTECA, CA 95336
- **Mailing address phone:** (209) 823-1788
- **Mailing address fax:** (209) 823-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100000071 | CA | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 12/22/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR05917H | — | CA |