Provider Demographics
NPI:1962551713
Name:DUKE FACILITIES, INC
Entity type:Organization
Organization Name:DUKE FACILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:209-969-1576
Mailing Address - Street 1:1150 W ROBINHOOD DR
Mailing Address - Street 2:STE 2C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:209-474-9260
Practice Address - Street 1:403 GOYA DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2246
Practice Address - Country:US
Practice Address - Phone:209-472-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55G532315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC61061FMedicaid