Provider Demographics
NPI:1073038634
Name:MENDOZA ANGEL'S RESIDENTIAL CARE
Entity Type:Organization
Organization Name:MENDOZA ANGEL'S RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR MAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP LOUISE
Authorized Official - Middle Name:MACABIO
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-761-9624
Mailing Address - Street 1:4479 W PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-5187
Mailing Address - Country:US
Mailing Address - Phone:559-916-4626
Mailing Address - Fax:
Practice Address - Street 1:3559 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6704
Practice Address - Country:US
Practice Address - Phone:559-916-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health