Provider Demographics
NPI:1891785143
Name:R. FELLEN, INC.
Entity Type:Organization
Organization Name:R. FELLEN, INC.
Other - Org Name:SUNNYSIDE CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-233-6248
Mailing Address - Street 1:2939 S PEACH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9302
Mailing Address - Country:US
Mailing Address - Phone:559-233-6248
Mailing Address - Fax:559-233-3368
Practice Address - Street 1:2939 S PEACH AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9302
Practice Address - Country:US
Practice Address - Phone:559-233-6248
Practice Address - Fax:559-233-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000154314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR18427FMedicaid
CA555352Medicare Oscar/Certification
CA1082830001Medicare NSC