Provider Demographics
NPI:1376847814
Name:XENCARE, INC.
Entity Type:Organization
Organization Name:XENCARE, INC.
Other - Org Name:FRESNO GUEST HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAZELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTNERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-434-1839
Mailing Address - Street 1:545 E CHESAPEAKE CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0740
Mailing Address - Country:US
Mailing Address - Phone:559-434-1839
Mailing Address - Fax:559-434-2551
Practice Address - Street 1:2214 E WARNER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4530
Practice Address - Country:US
Practice Address - Phone:559-434-1839
Practice Address - Fax:559-434-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-24
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107204171310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility