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General NPI Number Information
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NPI Number | 1114173358
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Entity Type | Organization
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Legal Business Name | SHEPHERD HOME
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 8893 N SIERRA VISTA AVE
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City | FRESNO
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State | CA
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Zip | 93720-3948
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Country | US
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Telephone | 559-298-7998
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Fax | 559-298-1551
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Provider Business Mailing Address
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Address Line | 8893 N SIERRA VISTA AVE
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City | FRESNO
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State | CA
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Zip | 93720-3948
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Country | US
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Telephone | 559-298-7998
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Fax | 559-298-1551
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Authorized Official
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Title or Position | OWNER
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Name | MR. LEE W SHEPHERD
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Credential |
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Telephone | 559-298-7998
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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 | 040000491
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License Number State | CA
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