Provider Demographics
NPI:1174014153
Name:FRESNO CONGREGATE LIVING INC
Entity Type:Organization
Organization Name:FRESNO CONGREGATE LIVING INC
Other - Org Name:FRESNO CONGREGATE LIVING INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRBOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-270-1073
Mailing Address - Street 1:3110 E SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3110 E SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5917
Practice Address - Country:US
Practice Address - Phone:559-270-1073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities