MEDICARE: FRUITFUL LIVING ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		CA

General Provider Information

NPI Number	:	1396156725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRUITFUL LIVING ENTERPRISES

Provider Business Mailing Address
First Line	:	467 SARATOGA AVE
Second Line	:	STE. 221
City	:	SAN JOSE
State	:	CA
Zip	:	95129-1326
Country	:	US
Telephone Number	:	408-249-0095
Fax Number	:	408-588-1619

Provider Business Practice Location Address
First Line	:	467 SARATOGA AVE
Second Line	:	STE. 221
City	:	SAN JOSE
State	:	CA
Zip	:	95129-1326
Country	:	US
Telephone Number	:	408-249-0095
Fax Number	:	408-588-1619

Authorized Official
Title or Position	:	CEO
Name	:	JANIS KING
Credential	:
Telephone Number	:	408-515-9478

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	08/10/2023

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