Provider Demographics
NPI:1083147870
Name:FORTUNE SENIOR ENTERPRISES
Entity Type:Organization
Organization Name:FORTUNE SENIOR ENTERPRISES
Other - Org Name:COMFORT KEEPERS 388
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFFEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-532-4500
Mailing Address - Street 1:14570 MONO WAY STE G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8997
Mailing Address - Country:US
Mailing Address - Phone:209-532-4500
Mailing Address - Fax:209-532-4505
Practice Address - Street 1:14570 MONO WAY STE G
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8997
Practice Address - Country:US
Practice Address - Phone:209-532-4500
Practice Address - Fax:209-532-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care