Provider Demographics
NPI:1700581279
Name:SEQUOIA GROVE ASSISTED LIVING INC
Entity type:Organization
Organization Name:SEQUOIA GROVE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEGHOUHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-905-9518
Mailing Address - Street 1:787 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3009
Mailing Address - Country:US
Mailing Address - Phone:559-905-9518
Mailing Address - Fax:559-493-5612
Practice Address - Street 1:787 E MINARETS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3009
Practice Address - Country:US
Practice Address - Phone:559-905-9518
Practice Address - Fax:559-493-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility