Organization
GOOD SAMARITAN CARE PROVIDER LLC
Active
Other names
FOUR SEASONS CARE CENTER- LODI
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PRAXEDES BERNARDO DEMESA NHA (PRESIDENT/MANAGNG MEMBER)
(209) 406-6610
Entity
Organization
Contact information
Practice address
10740 OAKWILDE AVE, STOCKTON, CA 95212-9249
(209) 406-6610
(209) 451-4997
Mailing address
610 S FAIRMONT AVE, LODI, CA 95240-3835
(209) 367-7400
(209) 451-4997
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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