MEDICARE: TWILIGHT HAVEN

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	310400000X	Assisted Living Facility	100400622	CA
2	314000000X	Skilled Nursing Facility	100490817	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427057405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWILIGHT HAVEN

Provider Business Mailing Address
First Line	:	1717 S WINERY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-5011
Country	:	US
Telephone Number	:	559-251-8417
Fax Number	:	559-251-1103

Provider Business Practice Location Address
First Line	:	1717 S WINERY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-5011
Country	:	US
Telephone Number	:	559-251-8417
Fax Number	:	559-251-1103

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARON D BAILEY
Credential	:
Telephone Number	:	559-251-8417

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	05/03/2012

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Directions to “TWILIGHT HAVEN ” Practice Location

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