Provider Demographics
NPI:1063262475
Name:DE RESIDENTIAL CARE, INC
Entity type:Organization
Organization Name:DE RESIDENTIAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-801-8008
Mailing Address - Street 1:1337 W ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1337 W ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2441
Practice Address - Country:US
Practice Address - Phone:559-801-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility