Organization
TJD, LLC
Active
Other names
Anberry Rehabilitation Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WALTER GORMLY (MEMBER)
(714) 907-7677
Entity
Organization
Contact information
Practice address
1685 SHAFFER RD, ATWATER, CA 95301-4456
(209) 357-3420
(209) 356-2486
Mailing address
1685 SHAFFER RD, ATWATER, CA 95301-4456
(209) 357-3420
(209) 356-2486
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
040000070
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55244H
—
CA
01
—
ZZZM2405Z
BLUE SHIELD
CA
Enumeration date
03/14/2006
Last updated
11/13/2020
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