Basic Information
| Provider Information | |||||||||
| NPI: | 1407304678 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF TULARE HEALTH AND HUMAN SERVICES AGENCY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | VISALIA RECOVERY CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5957 S MOONEY BLVD | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932779394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596247445 | ||||||||
| FaxNumber: | 5596241067 | ||||||||
| Practice Location | |||||||||
| Address1: | 942 S SANTA FE ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932922912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596364000 | ||||||||
| FaxNumber: | 5596241067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2016 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | ORTIZ | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 5596247445 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 540002HN | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.