=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225117823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLOVIS ADULT DAY HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 W BULLARD AVE STE 113
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93612-0945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-298-3996
-----------------------------------------------------
Fax | 559-298-2074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 W BULLARD AVE STE 113
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93612-0945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-298-3996
-----------------------------------------------------
Fax | 559-298-2074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. KARL L. NOYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-298-3996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------