Basic Information
| Provider Information | |||||||||
| NPI: | 1770076945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESNO CARE HOLDINGS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8049 | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932908049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599013147 | ||||||||
| FaxNumber: | 5596679404 | ||||||||
| Practice Location | |||||||||
| Address1: | 5265 E HUNTINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937274013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592518244 | ||||||||
| FaxNumber: | 5592515138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | BIGELOW | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5599013147 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 040000137 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.