Basic Information
| Provider Information | |||||||||
| NPI: | 1467504530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTHCARE NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932916331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597374700 | ||||||||
| FaxNumber: | 5597341247 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595874532 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | HYDASH | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDEN CEO | ||||||||
| AuthorizedOfficialTelephone: | 5597374731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 261QF0400X | 550000368 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC71170F | 05 | CA | MEDICAID |