Vienna Convalescent Hospital, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100000111 Issued in CA

Legal business name

VIENNA CONVALESCENT HOSPITAL, INC.

Practice address

800 S Ham LN
Lodi, CA 95242-3543

Phone

(209) 368-7141

Fax

(209) 368-2163

NPI assigned

Jul 13, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Corey Wright

Title

Administrator

Phone

(209) 368-7141

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972501823. Details of each certification follow.

• CCN 055481 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 055481

Legal name

VIENNA CONVALESCENT HOSPITAL, INC.

Doing business as

VIENNA NURSING AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Oct 18, 2024

Beds

150

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Incorporated

Oct 8, 1966 in CA

Enrollment address

800 S. Ham Lane
Lodi, CA 95242-3543

Nursing home name

VIENNA NURSING AND REHABILITATION CENTER

Listed as

Vienna Nursing and Rehabilitation CenterCCN 055481 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

5 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

150137.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Edmund A Freund, MD

  • Family Medicine Physician
  • Lodi, CA
  • NPI 1740237155

  Adp of the SNF

  CMS ownership

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Edmund A Freund, MD

  • Family Medicine Physician
  • Lodi, CA
  • NPI 1740237155

  Nursing home

  Care Compare affiliation
• Joseph D Gayagoy, M.D.

  • Internal Medicine Physician
  • Lodi, CA
  • NPI 1386738458

  Nursing home

  Care Compare affiliation
• Kenneth H Mullen, MD

  • Family Medicine Physician
  • Lodi, CA
  • NPI 1922065721

  Nursing home

  Care Compare affiliation
• Bao Q Nguyen, MD

  • Family Medicine Physician
  • Stockton, CA
  • NPI 1821032475

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260144000000",
    "number": "1972501823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S HAM LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423543",
            "telephone_number": "209-368-7141",
            "fax_number": "209-368-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S HAM LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423543",
            "telephone_number": "209-368-7141",
            "fax_number": "209-368-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIENNA CONVALESCENT HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2009-12-07",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-368-7141",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05481F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Lodi, CA
• Providers in Lodi, 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 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.