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General NPI Number Information
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NPI Number | 1821589201
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Entity Type | Organization
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Legal Business Name | BK HOUSE OF GRACE AND JOY, INC.
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1463 N ARCHIE AVE
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City | FRESNO
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State | CA
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Zip | 93703-4308
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Country | US
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Telephone | 559-536-9065
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Fax | 559-570-8912
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Provider Business Mailing Address
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Address Line | 1463 N ARCHIE AVE
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City | FRESNO
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State | CA
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Zip | 93703-4308
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Country | US
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Telephone | 559-536-9065
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Fax | 559-570-8912
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Authorized Official
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Title or Position | RCFE ADMINISTRATOR
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Name | JOYCELYN BARE HOPPER
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Credential |
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Telephone | 559-940-9708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 107208794
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License Number State | CA
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