Provider Demographics
NPI:1538608898
Name:FRESNO COMMUNITY BASED ADULT SERVICE CENTER, LLC
Entity type:Organization
Organization Name:FRESNO COMMUNITY BASED ADULT SERVICE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEVAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATCHADOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-414-4530
Mailing Address - Street 1:1060 FULTON MALL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2512
Mailing Address - Country:US
Mailing Address - Phone:619-414-4530
Mailing Address - Fax:
Practice Address - Street 1:1060 FULTON MALL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2512
Practice Address - Country:US
Practice Address - Phone:619-414-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care