Healthcare Provider Details

I. General information

NPI: 1134480817
Provider Name (Legal Business Name): HUMANGOOD FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 N FRESNO ST
FRESNO CA
93710
US

IV. Provider business mailing address

1900 HUNTINGTON DR
DUARTE CA
91010-2694
US

V. Phone/Fax

Practice location:
  • Phone: 559-430-8202
  • Fax: 559-439-3569
Mailing address:
  • Phone: 818-247-0420
  • Fax: 949-528-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000142
License Number StateCA

VIII. Authorized Official

Name: GWEN ELLEN VANGELISTO
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 949-463-0893