Palm Haven Nursing & Rehab LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100000071 Issued in CA

Legal business name

PALM HAVEN NURSING & REHAB LLC

Practice address

469 E North St
Manteca, CA 95336

Phone

(209) 823-1788

Fax

(209) 823-9809

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Joseph Pallivathucal

Title

General Manager

Phone

(209) 823-1788

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St Jude Care Center Doing business as

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1629097761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "95336",
            "telephone_number": "209-823-1788",
            "fax_number": "209-823-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "95336",
            "telephone_number": "209-823-1788",
            "fax_number": "209-823-9809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM HAVEN NURSING & REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "PALLIVATHUCAL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "209-823-1788"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05917H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Jude Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Jane Padilla
• Tanesia Rashell Paige Balumbu, LCSW
• Alexander Paiz
• Caramia Bianca Pallotta, P.T.
• Henry Alan Pallotta, P.T.
• Pamela M. Andrews DDS Ubc
• Ali Pandamouz, M.D.
• Hemadri Pandya
• Eun Jin Park
• Eunji Park, DDS

• 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 Dec 22, 2015; 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.