Healthcare Provider Details

I. General information

NPI: 1346321858
Provider Name (Legal Business Name): HUMANGOOD FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N FRESNO ST
FRESNO CA
93710
US

IV. Provider business mailing address

6120 STONERIDGE MALL RD FL 3 ABHOW
PLEASANTON CA
94588-3296
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-4770
  • Fax: 559-439-3569
Mailing address:
  • Phone: 925-924-7100
  • Fax: 925-924-7101

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: KATE WINTER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 925-924-7115