MEDICARE: CALIFORNIA HOME FOR THE AGED, INC.

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	310400000X	Assisted Living Facility		CA
2	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487654646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA HOME FOR THE AGED, INC.

Provider Business Mailing Address
First Line	:	6720 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-3603
Country	:	US
Telephone Number	:	559-251-8414
Fax Number	:	559-251-5766

Provider Business Practice Location Address
First Line	:	6720 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-3603
Country	:	US
Telephone Number	:	559-251-8414
Fax Number	:	559-251-5766

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MATTHEW DEMCHUK
Credential	:
Telephone Number	:	559-251-8414

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/11/2025

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