Provider Demographics
NPI:1225208440
Name:A & C HEALTH CARE SERVICES, INC
Entity type:Organization
Organization Name:A & C HEALTH CARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMPARO
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAGUDO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:408-226-0300
Mailing Address - Street 1:5615 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3625
Mailing Address - Country:US
Mailing Address - Phone:408-226-0300
Mailing Address - Fax:408-226-3800
Practice Address - Street 1:900 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-1282
Practice Address - Country:US
Practice Address - Phone:209-333-1222
Practice Address - Fax:209-333-1816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A & C HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000220314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-5164Medicaid
CA55-5164 LTC55164GMedicaid
CA55-5164 LTC55164GMedicaid