Healthcare Provider Details

I. General information

NPI: 1891785143
Provider Name (Legal Business Name): R. FELLEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S PEACH AVE
FRESNO CA
93725-9302
US

IV. Provider business mailing address

2939 S PEACH AVE
FRESNO CA
93725-9302
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-6248
  • Fax: 559-233-3368
Mailing address:
  • Phone: 559-233-6248
  • Fax: 559-233-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000154
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL FELLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-233-6248