Provider Demographics
NPI:1306582309
Name:SIERRA MEADOWS SENIOR CARE, INC.
Entity type:Organization
Organization Name:SIERRA MEADOWS SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HELENA
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-840-0452
Mailing Address - Street 1:5425 W SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2362
Mailing Address - Country:US
Mailing Address - Phone:559-840-9347
Mailing Address - Fax:559-554-9606
Practice Address - Street 1:5425 W SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2362
Practice Address - Country:US
Practice Address - Phone:559-840-9347
Practice Address - Fax:559-554-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No291U00000XLaboratoriesClinical Medical Laboratory
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107209048OtherSTATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CA107209048OtherMEMORY CARE