Healthcare Provider Details

I. General information

NPI: 1073649307
Provider Name (Legal Business Name): VALLEY CARE RESIDENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 E PORTLAND AVE
FRESNO CA
93720-2081
US

IV. Provider business mailing address

1903 E FIR AVE 101
FRESNO CA
93720-3842
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-5025
  • Fax: 559-431-6985
Mailing address:
  • Phone: 559-322-9305
  • Fax: 559-322-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: ANDREA RENGSTORF
Title or Position: RN TREASURER
Credential:
Phone: 559-322-9305