Healthcare Provider Details

I. General information

NPI: 1396156725
Provider Name (Legal Business Name): FRUITFUL LIVING ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 SARATOGA AVE STE. 221
SAN JOSE CA
95129-1326
US

IV. Provider business mailing address

467 SARATOGA AVE STE. 221
SAN JOSE CA
95129-1326
US

V. Phone/Fax

Practice location:
  • Phone: 408-249-0095
  • Fax: 408-588-1619
Mailing address:
  • Phone: 408-249-0095
  • Fax: 408-588-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: JANIS KING
Title or Position: CEO
Credential:
Phone: 408-515-9478