Healthcare Provider Details

I. General information

NPI: 1518400886
Provider Name (Legal Business Name): RIMA AGARONYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 E ACACIA AVE
FRESNO CA
93726-0605
US

IV. Provider business mailing address

3274 E ACACIA AVE
FRESNO CA
93726-0605
US

V. Phone/Fax

Practice location:
  • Phone: 559-385-7115
  • Fax:
Mailing address:
  • Phone: 559-385-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number107206792
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number107206792
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number107206792
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number107206792
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number107206792
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number107206792
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number107206792
License Number StateCA

VIII. Authorized Official

Name: RIMA AGARONYAN
Title or Position: ADMIN
Credential:
Phone: 559-385-7115