1528588027 NPI number — DYCORA TRANSITIONAL HEALTH & LIVING -- TWIN OAKS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528588027 NPI number — DYCORA TRANSITIONAL HEALTH & LIVING -- TWIN OAKS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYCORA TRANSITIONAL HEALTH & LIVING -- TWIN OAKS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528588027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 W ALLUVIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93711-5507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-430-3901
Provider Business Mailing Address Fax Number:
559-430-3995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
897 N M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-687-1340
Provider Business Practice Location Address Fax Number:
559-684-8753
Provider Enumeration Date:
06/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JULIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
559-430-3901

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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