Healthcare Provider Details

I. General information

NPI: 1831100932
Provider Name (Legal Business Name): COMMUNITY LIVING CENTER - FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N MARIPOSA
FRESNO CA
93703
US

IV. Provider business mailing address

3003 N MARIPOSA
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-1711
  • Fax: 559-459-1799
Mailing address:
  • Phone: 559-459-1711
  • Fax: 559-459-1799

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: MS. LISA T MCQUONE
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 559-459-1711