TJD, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

040000070 Issued in CA

Legal business name

TJD, LLC

Practice address

1685 Shaffer Rd
Atwater, CA 95301-4456

Phone

(209) 357-3420

Fax

(209) 356-2486

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Donald Walter Gormly

Title

Member

Phone

(714) 907-7677

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Anberry Rehabilitation Hospital Doing business as

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1154399244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1685 SHAFFER RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953014456",
            "telephone_number": "209-357-3420",
            "fax_number": "209-356-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 SHAFFER RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953014456",
            "telephone_number": "209-357-3420",
            "fax_number": "209-356-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TJD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "GORMLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "714-907-7677"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "040000070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55244H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZM2405Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anberry Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anberry Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Atwater, CA
• Providers in Atwater, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.