Provider Demographics
NPI:1649979170
Name:VELAMMA LLC
Entity type:Organization
Organization Name:VELAMMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SASHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-472-8100
Mailing Address - Street 1:2804 MCKELVY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6059
Mailing Address - Country:US
Mailing Address - Phone:559-472-8100
Mailing Address - Fax:559-472-8100
Practice Address - Street 1:6572 N MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3820
Practice Address - Country:US
Practice Address - Phone:559-438-0980
Practice Address - Fax:559-438-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107209302OtherCOMMUNITY CARE LICENSING, DEPT OF SOCIAL SERVICES