STOCKTON EDISON HEALTHCARE CORPORATION (NPI# 1548283542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548283542 |
| Entity Type | Organization |
| Organization Name | STOCKTON EDISON HEALTHCARE CORPORATION |
| Other Organization Name | GOOD SAMARITAN REHAB & CARE CENTER |
| Practice Address |
1630 N. Edison St. Stockton CA 95204 |
| Mailing Address |
1630 N. Edison Street Stockton CA 95204 |
| Practice Telephone | 2099488762 |
| Practice Fax Number | 2099488503 |
| Mailing Telephone | 2099488762 |
| Mailing Fax Number | 8185417072 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-11-29 |
| Authorized Official Name | MS. PRAXEDES DEMESA BERNABE (PRESIDENT) |
| Authorized Official Telephone | 2099488762 |
| Authorized Official Credential | NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 314000000X | Skilled Nursing Facility | 230000012 | CA | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZR05039J | 05 |
| Other Name | Type Code |
|---|---|
| GOOD SAMARITAN REHAB & CARE CENTER | Doing Business As Name - Organization |
| Street Address |
1630 N. EDISON ST. |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316330152 | Waverly Place of Stockton, LLC | Skilled Nursing Facility | 501 E Front Avenue, Stockton, IL 61085 | 2015-03-17 |
| 1932507431 | Sandra Rae Divine | Skilled Nursing Facility | 1015 Lancaster Dr, Stockton, MO 65785-8360 | 2014-12-15 |
| 1114323136 | Good Samaritan Care Provider LLC | Skilled Nursing Facility | 10740 Oakwilde Ave, Stockton, CA 95212-9249 | 2014-11-19 |
| 1801938816 | Covenant Care California, LLC | Skilled Nursing Facility | 9289 Branstetter Place, Stockton, CA 95209-1700 | 2007-02-13 |
| 1730269184 | O'connor Woods Housing Corp | Skilled Nursing Facility | 3110 Wagner Heights Rd, Stockton, CA 95209-4848 | 2006-10-17 |
| 1891700464 | Kindred Nursing Centers West, LLC | Skilled Nursing Facility | 1517 E Knickerbocker Dr, Stockton, CA 95210-3119 | 2006-07-30 |
| 1871512046 | Helios Healthcare, LLC | Skilled Nursing Facility | 442 E Hampton St, Stockton, CA 95204-5519 | 2006-07-19 |
| 1922027002 | Helios Healthcare, LLC | Skilled Nursing Facility | 6940 Pacific Ave, Stockton, CA 95207-2602 | 2006-07-19 |
| 1487601704 | Sunbridge Stockton Rehabilitation Center LLC | Skilled Nursing Facility | 9107 Davis Rd, Stockton, CA 95209-1807 | 2006-05-30 |
| 1679529176 | Beverly Health and Rehabilitation Services, Inc. | Skilled Nursing Facility | 1221 Rosemarie Ln, Stockton, CA 95207-6703 | 2006-05-26 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.