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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
NANCY BARGMANN (VICE PRESIDENT)
(909) 579-3151
Entity
Organization

Contact information

Practice address
5704 N WHEELER AVE, FRESNO, CA 93722-2541
(559) 451-0399
Mailing address
229 BERRY DR, MADERA, CA 93637-4112

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LTC80349G
CA
Enumeration date
05/22/2007
Last updated
08/22/2020
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