Healthcare Provider Details

I. General information

NPI: 1205903176
Provider Name (Legal Business Name): CALIFORNIA HOME FOR THE AGED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 E KINGS CANYON RD
FRESNO CA
93727-3603
US

IV. Provider business mailing address

6720 E KINGS CANYON RD
FRESNO CA
93727-3603
US

V. Phone/Fax

Practice location:
  • Phone: 559-251-8414
  • Fax: 559-251-5766
Mailing address:
  • Phone: 559-251-8414
  • Fax: 559-251-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000081
License Number StateCA

VIII. Authorized Official

Name: MS. YUBA RADOJKOVICH
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-251-8414