Organization Active NPI

Central Valley Specialty Hospital, Inc.

  • Meals Provider
  • Modesto, CA
National Provider Identifier
1134470156
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Meals ProviderTaxonomy code 174200000X
Legal business name
CENTRAL VALLEY SPECIALTY HOSPITAL, INC.
Practice address
730 17TH St
Modesto, CA 95354-1209
Phone
(209) 576-2532
Fax
(209) 576-2598
NPI assigned
Oct 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Tammy Jean Thompson
Title
VP Finance
Phone
(209) 248-7851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Meals Provider 174200000X Primary

Addresses

Primary practice location

730 17TH St
Modesto, CA 95354-1209

Mailing address

1320 Standiford Ave
Suite 4 PMB 214
Modesto, CA 95350-0726
Phone (209) 576-2532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130212000549 CA Part A Provider - Hospital 8325292717 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA

Hospital certification: CCN 052055

Legal name
CENTRAL VALLEY SPECIALTY HOSPITAL INC
Doing business as
CENTRAL VALLEY SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Aug 28, 2013
Last certification
Jun 5, 2025
Beds
96
Ownership / control type
Private (for profit)
Organization structure
CorporationProprietary
Incorporated
Sep 11, 2012 in CA
Enrollment address
730 17TH St
Modesto, CA 95354-1209
Main/Primary Hospital Location
Hospital subgroups
Long-term

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Central Valley Specialty HospitalCCN 052055
Ownership
For profit
Certified
Aug 28, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Beds
36

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gurpreet Singh Randhawa Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Jul 1, 2015 100%
Corporate OfficerChief Executive Officer Jul 1, 2015 100%
Corporate DirectorChair Governing Board Jul 1, 2015 100%
W-2 Managing EmployeeCeo Jul 1, 2015 100%
Operational/Managerial ControlCeo Jul 1, 2015 100%
Shamsher Bhullar Individual Corporate DirectorVice Chair Governing Board Jul 13, 2022
Tammy Thompson Individual Corporate OfficerChief Financial Officer Jul 18, 2016
Corporate DirectorSecretary Governing Board Jul 18, 2016
Operational/Managerial ControlChief Financial Officer Jul 18, 2016
Dupinder Kaur Sidhu Individual Corporate OfficerAdministrator May 24, 2019
Corporate DirectorBoard Member Governing Body Jul 13, 2022
W-2 Managing EmployeeAdministrator May 24, 2019
Operational/Managerial ControlAdministrator May 24, 2019
Central Valley Specialty Hospital Inc Organization, Modesto, CA Corporation 5% Or Greater Direct Ownership Interest Sep 12, 2012 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1134470156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 STANDIFORD AVE",
            "address_2": "SUITE 4 PMB 214",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953500726",
            "telephone_number": "209-576-2532",
            "fax_number": "209-576-2598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 17TH ST",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541209",
            "telephone_number": "209-576-2532",
            "fax_number": "209-576-2598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY SPECIALTY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "209-248-7851"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.