Healthcare Provider Details

I. General information

NPI: 1477969335
Provider Name (Legal Business Name): MIJI CARE OF FRESNO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE STE 105
FRESNO CA
93711-3229
US

IV. Provider business mailing address

5805 SEPULVEDA BLVD STE 605
SHERMAN OAKS CA
91411-2550
US

V. Phone/Fax

Practice location:
  • Phone: 559-742-7000
  • Fax:
Mailing address:
  • Phone: 818-902-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN ISTRIN
Title or Position: PRESIDENT
Credential:
Phone: 818-902-4112