Healthcare Provider Details

I. General information

NPI: 1083147870
Provider Name (Legal Business Name): FORTUNE SENIOR ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14570 MONO WAY STE G
SONORA CA
95370-8997
US

IV. Provider business mailing address

14570 MONO WAY STE G
SONORA CA
95370-8997
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-4500
  • Fax: 209-532-4505
Mailing address:
  • Phone: 209-532-4500
  • Fax: 209-532-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCE MAFFEO
Title or Position: OWNER-PRESIDENT
Credential:
Phone: 209-532-4500