Provider Demographics
NPI:1912190703
Name:PACIFIC CARE HOMES 2
Entity Type:Organization
Organization Name:PACIFIC CARE HOMES 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-271-3431
Mailing Address - Street 1:4222 W ALAMOS AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3900
Mailing Address - Country:US
Mailing Address - Phone:559-271-3431
Mailing Address - Fax:559-271-2086
Practice Address - Street 1:4458 N CHARLES AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4109
Practice Address - Country:US
Practice Address - Phone:559-271-1921
Practice Address - Fax:559-271-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities