Organization
MAIN SOURCE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA DENISE IBRAHIM REGISTERED NURSE (CEO)
(800) 601-6571
Entity
Organization
Contact information
Practice address
2155 E TRENTON AVE, FRESNO, CA 93720-3924
(805) 453-0191
Mailing address
2155 E TRENTON AVE, FRESNO, CA 93720-3924
(805) 453-0191
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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