Provider Demographics
NPI:1598268922
Name:ANM DIVERSIFIED INC
Entity Type:Organization
Organization Name:ANM DIVERSIFIED INC
Other - Org Name:EVERSPRING RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZLOOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-392-0393
Mailing Address - Street 1:5738 N LOLA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2537
Mailing Address - Country:US
Mailing Address - Phone:559-392-0393
Mailing Address - Fax:
Practice Address - Street 1:5738 N LOLA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2537
Practice Address - Country:US
Practice Address - Phone:559-392-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107208848310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility