Healthcare Provider Details

I. General information

NPI: 1528625811
Provider Name (Legal Business Name): FRESNO NURSING AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 N 1ST ST
FRESNO CA
93726-6810
US

IV. Provider business mailing address

1376 E 3300 S
SALT LAKE CITY UT
84106-3069
US

V. Phone/Fax

Practice location:
  • Phone: 801-601-1450
  • Fax:
Mailing address:
  • Phone: 801-601-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BROOKE HIXSON
Title or Position: CONTROLLER
Credential:
Phone: 801-601-1450