Healthcare Provider Details

I. General information

NPI: 1356581318
Provider Name (Legal Business Name): ANGELINE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 E MICHIGAN AVE
FRESNO CA
93703-1136
US

IV. Provider business mailing address

2834 E MICHIGAN AVE
FRESNO CA
93703-1136
US

V. Phone/Fax

Practice location:
  • Phone: 559-289-2992
  • Fax: 559-227-6534
Mailing address:
  • Phone: 559-289-2992
  • Fax: 559-227-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. HECTOR FLORES GONZALES I
Title or Position: OWNER
Credential: CNA
Phone: 559-289-2992