NPIMap

Organization Active NPI

Good Samaritan Care Provider LLC

Doing business as Four Seasons Care Center- Lodi

  • Skilled Nursing Facility
  • Stockton, CA
National Provider Identifier
1114323136
Registry record updated Nov 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GOOD SAMARITAN CARE PROVIDER LLC
Doing business as
Four Seasons Care Center- Lodi
Practice address
10740 Oakwilde Ave
Stockton, CA 95212-9249
Phone
(209) 406-6610
Fax
(209) 451-4997
NPI assigned
Nov 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Praxedes Bernardo Demesa, NHA
Title
President/Managng Member
Phone
(209) 406-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

10740 Oakwilde Ave
Stockton, CA 95212-9249

Mailing address

610 S Fairmont Ave
Lodi, CA 95240-3835
Phone (209) 367-7400

Other names 1

  • FOUR SEASONS CARE CENTER- LODI Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Four Seasons Care Center- Lodi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1114323136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952403835",
            "telephone_number": "209-367-7400",
            "fax_number": "209-451-4997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10740 OAKWILDE AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952129249",
            "telephone_number": "209-406-6610",
            "fax_number": "209-451-4997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN CARE PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "DEMESA",
        "authorized_official_first_name": "PRAXEDES",
        "authorized_official_middle_name": "BERNARDO",
        "authorized_official_title_or_position": "PRESIDENT/MANAGNG MEMBER",
        "authorized_official_telephone_number": "209-406-6610",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOUR SEASONS CARE CENTER- LODI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.