Healthcare Provider Details

I. General information

NPI: 1740139666
Provider Name (Legal Business Name): SHEPHERDS HEART CENTRAL VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 E LINCOLN AVE
FOWLER CA
93625-9521
US

IV. Provider business mailing address

8881 E LINCOLN AVE
FOWLER CA
93625-9521
US

V. Phone/Fax

Practice location:
  • Phone: 951-288-2841
  • Fax:
Mailing address:
  • Phone: 951-288-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYNE OTERO
Title or Position: CEO
Credential:
Phone: 951-288-2841