Provider Demographics
NPI:1396229548
Name:VICTORIAS CARE HOME
Entity Type:Organization
Organization Name:VICTORIAS CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHIRN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVOODI ALIABAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-482-6166
Mailing Address - Street 1:5161 W PALO ALTO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3607
Mailing Address - Country:US
Mailing Address - Phone:408-482-6166
Mailing Address - Fax:
Practice Address - Street 1:5161 W PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3607
Practice Address - Country:US
Practice Address - Phone:408-482-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility