Basic Information
| Provider Information | |||||||||
| NPI: | 1336660414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYCORA TRANSITIONAL HEALTH & LIVING -- MEMORY CARE OF TULARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 W ALLUVIAL AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937115507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594303901 | ||||||||
| FaxNumber: | 5594303995 | ||||||||
| Practice Location | |||||||||
| Address1: | 604 E MERRITT AVE | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932742135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596861601 | ||||||||
| FaxNumber: | 5596868448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | JULIANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5594303901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.