Provider Demographics
NPI:1205903176
Name:CALIFORNIA HOME FOR THE AGED, INC.
Entity type:Organization
Organization Name:CALIFORNIA HOME FOR THE AGED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOJKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-251-8414
Mailing Address - Street 1:6720 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3603
Mailing Address - Country:US
Mailing Address - Phone:559-251-8414
Mailing Address - Fax:559-251-5766
Practice Address - Street 1:6720 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3603
Practice Address - Country:US
Practice Address - Phone:559-251-8414
Practice Address - Fax:559-251-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000081314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05955FMedicaid
CAZZR05955FMedicaid