Basic Information
| Provider Information | |||||||||
| NPI: | 1114070851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESNO COUNTY REEDLEY MENTAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4441 E KINGS CANYON RD | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937023604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592539180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1131 I ST | ||||||||
| Address2: | |||||||||
| City: | REEDLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936543314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596388588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | GIANG | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, FRESNO CO MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 5592539180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 000001054 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 2334 | 01 | COST CENTER | OTHER | 000001054 | 05 | CA | MEDICAID |