Healthcare Provider Details

I. General information

NPI: 1972576643
Provider Name (Legal Business Name): COVENANT CARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 S PEACH AVE
FRESNO CA
93727-3952
US

IV. Provider business mailing address

577 S PEACH AVE
FRESNO CA
93727-3952
US

V. Phone/Fax

Practice location:
  • Phone: 559-251-8463
  • Fax: 559-251-4465
Mailing address:
  • Phone: 559-251-8463
  • Fax: 559-251-4465

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: MR. BART J VANDERWAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-251-8463