Healthcare Provider Details

I. General information

NPI: 1013005347
Provider Name (Legal Business Name): KINGS/TULARE AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-737-4660
  • Fax: 559-737-4698
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DAVIS
Title or Position: DIRECTOR HEALTH AND HUMAN SERVICES
Credential:
Phone: 559-737-4660