Provider Demographics
NPI:1932651130
Name:DYCORA TRANSITIONAL HEALTH - FRESNO LLC
Entity Type:Organization
Organization Name:DYCORA TRANSITIONAL HEALTH - FRESNO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-486-4433
Mailing Address - Street 1:2715 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1304
Mailing Address - Country:US
Mailing Address - Phone:559-486-4433
Mailing Address - Fax:
Practice Address - Street 1:2715 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1304
Practice Address - Country:US
Practice Address - Phone:559-486-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility