Healthcare Provider Details

I. General information

NPI: 1255840708
Provider Name (Legal Business Name): CHOWCHILLA CARE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 VENTURA AVE
CHOWCHILLA CA
93610-2368
US

IV. Provider business mailing address

4616 W MODOC CT
VISALIA CA
93291-9384
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-4826
  • Fax: 559-665-4074
Mailing address:
  • Phone: 559-901-3147
  • Fax: 559-713-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number040000082
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000082
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRANDON DAVID BIGELOW
Title or Position: OWNER/CEO
Credential:
Phone: 559-901-3147