Provider Demographics
NPI:1073507562
Name:TDC CONVALESCENT INC.
Entity Type:Organization
Organization Name:TDC CONVALESCENT INC.
Other - Org Name:HORIZON HEALTH AND SUBACUTE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-652-4712
Mailing Address - Street 1:3034 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0300
Mailing Address - Country:US
Mailing Address - Phone:559-321-0883
Mailing Address - Fax:559-321-7783
Practice Address - Street 1:3034 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0300
Practice Address - Country:US
Practice Address - Phone:559-321-0883
Practice Address - Fax:559-321-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05199KMedicaid
CALTC70096FMedicaid
CA055199Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER