Healthcare Provider Details

I. General information

NPI: 1316467665
Provider Name (Legal Business Name): DYCORA TRANSITIONAL HEALTH & LIVING -- PORTERVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MORTON AVE
PORTERVILLE CA
93257-1947
US

IV. Provider business mailing address

650 W ALLUVIAL AVE
FRESNO CA
93711-5507
US

V. Phone/Fax

Practice location:
  • Phone: 559-782-1509
  • Fax: 559-781-5220
Mailing address:
  • Phone: 559-430-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIANNE WILLIAMS
Title or Position: CEO
Credential:
Phone: 559-430-3901