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General NPI Number Information
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NPI Number | 1639548308
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Entity Type | Organization
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Legal Business Name | DRAGONFRUIT HOLDINGS, LLC
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 180 N JACKSON AVE
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City | SAN JOSE
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State | CA
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Zip | 95116-1907
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Country | US
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Telephone | 408-259-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 262 N UNIVERSITY AVE # 200
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City | FARMINGTON
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State | UT
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Zip | 84025-2975
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN MITCHELL
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Credential |
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Telephone | 385-518-1814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | CA
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