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Organization
LODI SKILLED NURSING SERVICES, INC.
Active
Organization
LODI SKILLED NURSING SERVICES, INC.
Active
Other names
Fairmont Rehabilitation Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MARC JOHNSON (CFO)
(949) 373-8373
Entity
Organization
Contact information
Practice address
950 S FAIRMONT AVE, LODI, CA 95240
(209) 368-0693
(209) 339-9759
Mailing address
25910 ACERO STE 350, MISSION VIEJO, CA 92691-7908
(949) 441-9258
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100000039
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05242I
—
CA
Enumeration date
05/26/2006
Last updated
04/05/2024
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