Healthcare Provider Details

I. General information

NPI: 1386009306
Provider Name (Legal Business Name): IDEAL CARE CENTERS INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 W DAYTON AVE
FRESNO CA
93722-4704
US

IV. Provider business mailing address

3618 W DAYTON AVE
FRESNO CA
93722-4704
US

V. Phone/Fax

Practice location:
  • Phone: 559-275-2488
  • Fax: 559-275-2488
Mailing address:
  • Phone: 559-275-2488
  • Fax: 559-275-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number107206776
License Number StateCA

VIII. Authorized Official

Name: MR. GREGORY AIFEHIENGBE IDONI
Title or Position: PRESIDENT / CEO
Credential:
Phone: 559-718-8857