Organization
VALLEY CARE RESIDENTIAL
Active
Other names
Portland House
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA RENGSTORF (RN TREASURER)
(559) 322-9305
Entity
Organization
Contact information
Practice address
186 E PORTLAND AVE, FRESNO, CA 93720-2081
(559) 432-5025
(559) 431-6985
Mailing address
1903 E FIR AVE, 101, FRESNO, CA 93720-3842
(559) 322-9305
(559) 322-9882
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC80096G
LONG TERM CARE PROVIDER
CA
Enumeration date
02/23/2007
Last updated
08/22/2020
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