Provider Demographics
NPI:1134480817
Name:HUMANGOOD FRESNO
Entity Type:Organization
Organization Name:HUMANGOOD FRESNO
Other - Org Name:THE TERRACES AT SAN JOAQUIN GARDENS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-924-7115
Mailing Address - Street 1:6120 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3296
Mailing Address - Country:US
Mailing Address - Phone:925-924-7100
Mailing Address - Fax:925-924-7101
Practice Address - Street 1:5551 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-430-8202
Practice Address - Fax:559-439-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000142314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055846Medicare Oscar/Certification