Provider Demographics
NPI:1821589201
Name:BK HOUSE OF GRACE AND JOY, INC.
Entity Type:Organization
Organization Name:BK HOUSE OF GRACE AND JOY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCFE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCELYN
Authorized Official - Middle Name:BARE
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-940-9708
Mailing Address - Street 1:1463 N ARCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4308
Mailing Address - Country:US
Mailing Address - Phone:559-536-9065
Mailing Address - Fax:559-570-8912
Practice Address - Street 1:1463 N ARCHIE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4308
Practice Address - Country:US
Practice Address - Phone:559-536-9065
Practice Address - Fax:559-570-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107208794310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility