Healthcare Provider Details

I. General information

NPI: 1235208349
Provider Name (Legal Business Name): FRESNO HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 A ST
FRESNO CA
93706-3202
US

IV. Provider business mailing address

1101 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-6317
  • Fax:
Mailing address:
  • Phone: 323-935-8490
  • Fax: 323-935-8494

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: MRS. JEOUNG HANS LEE
Title or Position: PRESIDENT CEO
Credential:
Phone: 323-935-8490