Healthcare Provider Details

I. General information

NPI: 1962576447
Provider Name (Legal Business Name): MELENDEZ FAMILY HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 ROAD 238
TERRA BELLA CA
93270-9703
US

IV. Provider business mailing address

9055 ROAD 238
TERRA BELLA CA
93270-9703
US

V. Phone/Fax

Practice location:
  • Phone: 559-535-0233
  • Fax: 559-535-7620
Mailing address:
  • Phone: 559-535-0233
  • Fax: 559-535-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JOSE ARTURO MELENDEZ
Title or Position: LICENSEE
Credential:
Phone: 559-535-0233