NPIMap

Organization Active NPI

Covenant Care of California

  • Skilled Nursing Facility
  • Fresno, CA
National Provider Identifier
1972576643
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
COVENANT CARE OF CALIFORNIA
Practice address
577 S Peach Ave
Fresno, CA 93727-3952
Phone
(559) 251-8463
Fax
(559) 251-4465
NPI assigned
Feb 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Bart J Vanderwal
Title
Executive Director
Phone
(559) 251-8463

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X CA Primary

Addresses

Primary practice location

577 S Peach Ave
Fresno, CA 93727-3952

Mailing address

577 S Peach Ave
Fresno, CA 93727-3952
Phone (559) 251-8463

Other identifiers 1

IdentifierTypeStateIssuer
ZZR06207JMedicaidCA

Other names 1

  • Pacific Gardens Nursing and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Covenant Care California Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972576643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 S PEACH AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273952",
            "telephone_number": "559-251-8463",
            "fax_number": "559-251-4465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "577 S PEACH AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273952",
            "telephone_number": "559-251-8463",
            "fax_number": "559-251-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VANDERWAL",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "559-251-8463",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR06207J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Gardens Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.