Healthcare Provider Details

I. General information

NPI: 1639652613
Provider Name (Legal Business Name): CENTRAL VALLEY TLCF , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 12/14/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 W KANAI AVE
PORTERVILLE CA
93257-1874
US

IV. Provider business mailing address

1760 W KANAI AVE
PORTERVILLE CA
93257-1874
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-5796
  • Fax: 559-783-1957
Mailing address:
  • Phone: 559-781-5796
  • Fax: 559-783-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JOANYE LYNORA STUMP
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 559-920-0998