Healthcare Provider Details

I. General information

NPI: 1104064575
Provider Name (Legal Business Name): FRESNO SKILLED NURSING & WELLNESS CENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 M ST
FRESNO CA
93721-1121
US

IV. Provider business mailing address

1665 M ST
FRESNO CA
93721-1121
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-5361
  • Fax: 323-634-1943
Mailing address:
  • Phone: 559-268-5361
  • Fax: 323-634-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000200
License Number StateCA

VIII. Authorized Official

Name: SHLOMO RECHNITZ
Title or Position: MANAGER
Credential:
Phone: 626-800-1191