Provider Demographics
NPI:1255607040
Name:FRUITFUL LIVING ENTERPRISES
Entity type:Organization
Organization Name:FRUITFUL LIVING ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-515-9478
Mailing Address - Street 1:467 SARATOGA AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1326
Mailing Address - Country:US
Mailing Address - Phone:408-515-9478
Mailing Address - Fax:408-588-1619
Practice Address - Street 1:467 SARATOGA AVE
Practice Address - Street 2:STE 215
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1326
Practice Address - Country:US
Practice Address - Phone:408-249-4697
Practice Address - Fax:408-588-1619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRUITFUL LIVING ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care