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General NPI Number Information
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NPI Number | 1073649307
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Entity Type | Organization
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Legal Business Name | VALLEY CARE RESIDENTIAL
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 186 E PORTLAND AVE
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City | FRESNO
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State | CA
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Zip | 93720-2081
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Country | US
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Telephone | 559-432-5025
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Fax | 559-431-6985
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Provider Business Mailing Address
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Address Line | 1903 E FIR AVE 101
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City | FRESNO
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State | CA
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Zip | 93720-3842
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Country | US
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Telephone | 559-322-9305
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Fax | 559-322-9882
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Authorized Official
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Title or Position | RN TREASURER
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Name | ANDREA RENGSTORF
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Credential |
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Telephone | 559-322-9305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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