Healthcare Provider Details

I. General information

NPI: 1801930599
Provider Name (Legal Business Name): FRESNO LONG TERM CARE MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 N 6TH ST STE 149
FRESNO CA
93710-7505
US

IV. Provider business mailing address

5150 N 6TH ST STE 149
FRESNO CA
93710-7505
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-6500
  • Fax: 559-222-6555
Mailing address:
  • Phone: 559-222-6500
  • Fax: 559-222-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHA PRITPAL SINGH SIDHU
Title or Position: M.D.
Credential:
Phone: 559-222-6500