Provider Demographics
NPI:1992809156
Name:HCM QUINCY CONVALESCENT HOSP INC
Entity type:Organization
Organization Name:HCM QUINCY CONVALESCENT HOSP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-707-8737
Mailing Address - Street 1:50 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9718
Mailing Address - Country:US
Mailing Address - Phone:530-283-2110
Mailing Address - Fax:530-283-2274
Practice Address - Street 1:50 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9718
Practice Address - Country:US
Practice Address - Phone:530-283-2110
Practice Address - Fax:530-283-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-08-16
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-16
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06265JMedicaid
CAZZR06265JMedicaid