Healthcare Provider Details

I. General information

NPI: 1942301627
Provider Name (Legal Business Name): DELTA NURSING & REHABILITATION HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E MURRAY AVE
VISALIA CA
93291-5053
US

IV. Provider business mailing address

514 N BRIDGE ST
VISALIA CA
93291-5015
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4003
  • Fax: 559-625-4113
Mailing address:
  • Phone: 559-732-8614
  • Fax: 559-732-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120000558
License Number StateCA

VIII. Authorized Official

Name: MR. MARK ALLAN FISHER
Title or Position: PRESIDENT
Credential:
Phone: 559-625-4003