Healthcare Provider Details

I. General information

NPI: 1508318700
Provider Name (Legal Business Name): DYCORA TRANSITIONAL HEALTH - CLOVIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BARSTOW AVE
CLOVIS CA
93612-2225
US

IV. Provider business mailing address

111 BARSTOW AVE
CLOVIS CA
93612-2225
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2591
  • Fax:
Mailing address:
  • Phone: 559-299-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY HAWKINS
Title or Position: EXECUTIVE
Credential:
Phone: 559-299-2591