Healthcare Provider Details

I. General information

NPI: 1295278059
Provider Name (Legal Business Name): DYCORA TRANSITIONAL HEALTH-MEMORY CARE OF FRESNO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N CORNELIA AVE
FRESNO CA
93706-1031
US

IV. Provider business mailing address

925 N CORNELIA AVE
FRESNO CA
93706-1031
US

V. Phone/Fax

Practice location:
  • Phone: 559-275-4785
  • Fax:
Mailing address:
  • Phone: 559-275-4785
  • Fax:

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: MARY HAWKINS
Title or Position: EXECUTIVE
Credential:
Phone: 559-275-4785