Provider Demographics
NPI:1225384936
Name:SIERRA PALACE FOR ELDERLY, INC
Entity Type:Organization
Organization Name:SIERRA PALACE FOR ELDERLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:EVEA
Authorized Official - Last Name:PERERA-MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-246-7371
Mailing Address - Street 1:607 E. SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-435-6345
Mailing Address - Fax:559-435-2241
Practice Address - Street 1:607 E SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3925
Practice Address - Country:US
Practice Address - Phone:559-435-6345
Practice Address - Fax:559-435-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107200486320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities