Provider Demographics
NPI:1609223098
Name:FSH FISHER
Entity Type:Organization
Organization Name:FSH FISHER
Other - Org Name:COUNTRY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-330-6501
Mailing Address - Street 1:22371 BANDUCCI RD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-7720
Mailing Address - Country:US
Mailing Address - Phone:661-822-6457
Mailing Address - Fax:661-822-6458
Practice Address - Street 1:22371 BANDUCCI RD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-7720
Practice Address - Country:US
Practice Address - Phone:661-822-6457
Practice Address - Fax:661-822-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155801217310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility