Provider Demographics
NPI:1295832665
Name:AHWAHNEE CARE HOMES, INC.
Entity Type:Organization
Organization Name:AHWAHNEE CARE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-658-2444
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:AHWAHNEE
Mailing Address - State:CA
Mailing Address - Zip Code:93601-0346
Mailing Address - Country:US
Mailing Address - Phone:559-658-2444
Mailing Address - Fax:559-641-7898
Practice Address - Street 1:444665 ROAD 619
Practice Address - Street 2:
Practice Address - City:AHWAHNEE
Practice Address - State:CA
Practice Address - Zip Code:93601
Practice Address - Country:US
Practice Address - Phone:559-658-2444
Practice Address - Fax:559-641-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05G815315P00000X
CA05G904315P00000X
CA55G074315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80133FMedicaid
CALTC80200FMedicaid
CALTC80099FMedicaid