Healthcare Provider Details

I. General information

NPI: 1487868402
Provider Name (Legal Business Name): SAFE HARBOR ADULT DAY HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 VAN NESS AVE
FRESNO CA
93721-2620
US

IV. Provider business mailing address

853 VAN NESS AVE
FRESNO CA
93721-2620
US

V. Phone/Fax

Practice location:
  • Phone: 559-442-4567
  • Fax: 559-442-0751
Mailing address:
  • Phone: 559-442-4567
  • Fax: 559-442-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number070000536
License Number StateCA

VIII. Authorized Official

Name: MRS. JOANIE PATRICIA BALLANTYNE
Title or Position: PRESIDENT
Credential: R.N.
Phone: 559-442-4567