Stockton Congregational Homes

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100000076 Issued in CA

Legal business name

STOCKTON CONGREGATIONAL HOMES

Doing business as

Plymouth Square

Practice address

1319 N Madison St
Stockton, CA 95202-1047

Phone

(209) 466-4341

Fax

(209) 466-8853

NPI assigned

Jun 14, 2005

Last updated

Sep 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stuart Hartman

Title

V.P. of Operations

Phone

(562) 257-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PLYMOUTH SQUARE Doing business as

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1255336533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 N MADISON ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021047",
            "telephone_number": "209-466-4341",
            "fax_number": "209-466-8853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 N MADISON ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021047",
            "telephone_number": "209-466-4341",
            "fax_number": "209-466-8853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON CONGREGATIONAL HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "HARTMAN",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "V.P. OF OPERATIONS",
        "authorized_official_telephone_number": "562-257-5100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255336533",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RCFE",
            "identifier": "390300536",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLYMOUTH SQUARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Stockert, CPO
• Simone Amanda Stocks
• Stockton Cardio Thoracic Surg MD G
• Stockton Cardiology Medical Group Complete Heart Care Inc
• Stockton Circle of Friends Adult Programs
• Stockton Congregational Homes (Plymouth Square)
• Stockton Dental Group
• Stockton Detox Center
• Stockton Diagnostic Imaging
• Stockton Edison Healthcare Corporation (Good Samaritan Rehab & Care Center)

• Skilled Nursing Facility in Stockton, CA
• Providers in Stockton, 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 Sep 16, 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.