Basic Information
| Provider Information | |||||||||
| NPI: | 1568590347 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 ROBINSON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936125885 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2772 MARTIN LUTHER KING BLVD. | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592654800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LY | ||||||||
| AuthorizedOfficialFirstName: | XAN SAII | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMISSIONS SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5599031037 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.