Organization
VIENNA CONVALESCENT HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY WRIGHT (ADMINISTRATOR)
(209) 368-7141
Entity
Organization
Contact information
Practice address
800 S HAM LN, LODI, CA 95242-3543
(209) 368-7141
(209) 368-2163
Mailing address
800 S HAM LN, LODI, CA 95242-3543
(209) 368-7141
(209) 368-2163
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100000111
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05481F
—
CA
Enumeration date
07/13/2005
Last updated
12/07/2009
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