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1868 E.Hazelton Ave. •Stockton, CA 95205-6232 •Phone (209)468-3420 <br />Jasjit Kang, R.E.H.S., Director <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENTAL HEALTH <br />PERMIT TO OPERATE - PE 1628 - LICENSED HEALTH CARE FACILITY <br />Permit ID # PT0019099 for Record ID # PR0527300 <br />Valid From 8/1/2021 To 7/31/2022 <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s) Valid only for: <br />DBA: <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />LODI SKILLED NURSING SVC <br />FAIRMONT REHABILITATION HOSPIT <br />Regulated Facility: <br />950 S FAIRMONT AVE <br />LODI, CA 95240 <br />Facility ID <br />Account ID <br />Issued <br />FA0009730 <br />AR0016730 <br />7/14/2021 <br />FAIRMONT REHABILITATION HOSPITAL <br />ATTN : Billing Address: <br />FAIRMONT REHABILITATION HOSPITAL <br />950 S FAIRMONT AVE <br />LODI, CA 95240 <br />End of reportcombined.rpt