Provider Demographics
NPI:1982147492
Name:CITADEL & IVAN LLC
Entity Type:Organization
Organization Name:CITADEL & IVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CITADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-355-8956
Mailing Address - Street 1:5100 N 6TH ST
Mailing Address - Street 2:SUITE150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7514
Mailing Address - Country:US
Mailing Address - Phone:559-227-7202
Mailing Address - Fax:559-227-7203
Practice Address - Street 1:5100 N 6TH ST
Practice Address - Street 2:SUITE150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7514
Practice Address - Country:US
Practice Address - Phone:559-227-7202
Practice Address - Fax:559-227-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based