MEDICARE: LAVANG CARE HOMES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1275702334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVANG CARE HOMES INC

Provider Business Mailing Address
First Line	:	55 SHAW AVE
Second Line	:	SUITE 122
City	:	CLOVIS
State	:	CA
Zip	:	93612-3819
Country	:	US
Telephone Number	:	559-299-4954
Fax Number	:	559-299-0345

Provider Business Practice Location Address
First Line	:	5938 E SAGINAW WAY
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7974
Country	:	US
Telephone Number	:	559-293-4535
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JEREMY DAVID WINANS
Credential	:
Telephone Number	:	559-299-4954

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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Directions to “LAVANG CARE HOMES INC ” Practice Location

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