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General NPI Number Information
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NPI Number | 1477969335
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Entity Type | Organization
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Legal Business Name | MIJI CARE OF FRESNO, INC.
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 3433 W SHAW AVE STE 105
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City | FRESNO
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State | CA
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Zip | 93711-3229
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Country | US
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Telephone | 559-742-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 SEPULVEDA BLVD STE 605
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-2550
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Country | US
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Telephone | 818-902-4112
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN ISTRIN
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Credential |
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Telephone | 818-902-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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