Healthcare Provider Details

I. General information

NPI: 1073507562
Provider Name (Legal Business Name): TDC CONVALESCENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 E HERNDON AVE
FRESNO CA
93720-0300
US

IV. Provider business mailing address

3034 E HERNDON AVE
FRESNO CA
93720-0300
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-0883
  • Fax: 559-321-7783
Mailing address:
  • Phone: 559-321-0883
  • Fax: 559-321-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS CLARK
Title or Position: PRESIDENT
Credential:
Phone: 916-652-4712