Kaiser Foundation Hospitals

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

030000393 Issued in CA

Legal business name

KAISER FOUNDATION HOSPITALS

Practice address

1777 W Yosemite Ave
Manteca, CA 95337-5130

Phone

(209) 825-3625

Fax

(209) 825-3627

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Deborah Friberg

Title

Sr. VP/Area Manager

Phone

(209) 735-4146

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• KAISER FOUNDATION HOSPITAL-MANTECA DPSNF Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1154496867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 W YOSEMITE AVE",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953375130",
            "telephone_number": "209-825-3625",
            "fax_number": "209-825-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 W YOSEMITE AVE",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953375130",
            "telephone_number": "209-825-3625",
            "fax_number": "209-825-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "FRIBERG",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "SR. VP/AREA MANAGER",
        "authorized_official_telephone_number": "209-735-4146"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "030000393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55601H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC70075H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093734",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1777 W Yosemite Ave",
            "city": "Manteca",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953375130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER FOUNDATION HOSPITAL-MANTECA DPSNF",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER FOUNDATION HOSPITAL-MANTECA DPSNF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Jurkota, NCC, LPC
• Jamie Justice
• Kuljeet Kaur Kaberwal, NP
• Herleen K Kailey, M.D.
• Kaiser Foundation Health Plan Inc
• Kaiser Foundation Hospitals
• Kaiser Foundation Hospitals
• Manjot Kandola
• Karma Inc
• Abbas Kashani, M.D.

• Skilled Nursing Facility in Manteca, CA
• Providers in Manteca, 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 Apr 22, 2021; 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.