Provider Demographics
NPI:1316467665
Name:DYCORA TRANSITIONAL HEALTH & LIVING -- PORTERVILLE LLC
Entity type:Organization
Organization Name:DYCORA TRANSITIONAL HEALTH & LIVING -- PORTERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-430-3901
Mailing Address - Street 1:650 W ALLUVIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5507
Mailing Address - Country:US
Mailing Address - Phone:559-430-3901
Mailing Address - Fax:
Practice Address - Street 1:1100 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1947
Practice Address - Country:US
Practice Address - Phone:559-782-1509
Practice Address - Fax:559-781-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility