Provider Demographics
NPI:1295816569
Name:FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Entity Type:Organization
Organization Name:FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Other - Org Name:COMMUNITY SUBACUTE AND TRANSITIONAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-324-4884
Mailing Address - Street 1:2823 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1324
Mailing Address - Country:US
Mailing Address - Phone:559-459-1711
Mailing Address - Fax:559-459-1799
Practice Address - Street 1:3003 N MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1127
Practice Address - Country:US
Practice Address - Phone:559-459-1711
Practice Address - Fax:559-459-1799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC05258GMedicaid
CA055258Medicare Oscar/Certification