Dycora Transitional Health - Stockton LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DYCORA TRANSITIONAL HEALTH - STOCKTON LLC

Practice address

4545 Shelley CT
Stockton, CA 95207-7232

Phone

(209) 477-0271

NPI assigned

Oct 21, 2016

Last updated

Jan 24, 2018By 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

Mary Hawkins

Title

Executive

Phone

(209) 477-0271

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1710438981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 SHELLEY COURT",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952077232",
            "telephone_number": "209-477-0271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 SHELLEY CT",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952077232",
            "telephone_number": "209-477-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYCORA TRANSITIONAL HEALTH - STOCKTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-21",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE",
        "authorized_official_telephone_number": "209-477-0271"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Guadalupe None Dutra
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• Danyelle Annabelle Dwyer Manzo
• Dycora Transitional Health - Quail Lake LLC
• Dycora Transitional Health - Weber Oaks LLC
• Trina Eagal, FNP-BC
• Steven E Eager, MD
• Georgina Eagleton
• Angela Elaine Ealy-Hale

• 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 Jan 24, 2018; 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.