Provider Demographics
NPI:1497957609
Name:HEALTHY LIVING AT HOME - FRESNO LLC
Entity Type:Organization
Organization Name:HEALTHY LIVING AT HOME - FRESNO LLC
Other - Org Name:HEALTHY LIVING AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERHOEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-871-0766
Mailing Address - Street 1:2365 NORTHSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2720
Mailing Address - Country:US
Mailing Address - Phone:888-871-0766
Mailing Address - Fax:866-551-0846
Practice Address - Street 1:1270 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:559-675-5505
Practice Address - Fax:559-675-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07663GMedicaid
CAHHA07663GMedicaid