Provider Demographics
NPI:1386009306
Name:IDEAL CARE CENTERS INC,
Entity Type:Organization
Organization Name:IDEAL CARE CENTERS INC,
Other - Org Name:IDEAL CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:AIFEHIENGBE
Authorized Official - Last Name:IDONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-718-8857
Mailing Address - Street 1:3618 W DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4704
Mailing Address - Country:US
Mailing Address - Phone:559-275-2488
Mailing Address - Fax:559-275-2488
Practice Address - Street 1:3618 W DAYTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4704
Practice Address - Country:US
Practice Address - Phone:559-275-2488
Practice Address - Fax:559-275-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107206776311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)