Provider Demographics
NPI:1073649307
Name:VALLEY CARE RESIDENTIAL
Entity Type:Organization
Organization Name:VALLEY CARE RESIDENTIAL
Other - Org Name:PORTLAND HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:RN TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENGSTORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-322-9305
Mailing Address - Street 1:1903 E FIR AVE
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3842
Mailing Address - Country:US
Mailing Address - Phone:559-322-9305
Mailing Address - Fax:559-322-9882
Practice Address - Street 1:186 E PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2081
Practice Address - Country:US
Practice Address - Phone:559-432-5025
Practice Address - Fax:559-431-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80096GOtherLONG TERM CARE PROVIDER