Basic Information
| Provider Information | |||||||||
| NPI: | 1760618722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMINENCE HEALTHCARE SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27707 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937297707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592218100 | ||||||||
| FaxNumber: | 5592218101 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E BUSH ST | ||||||||
| Address2: | ROOMS C-3, ANNEX, 7-8 | ||||||||
| City: | LEMOORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932453601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592218100 | ||||||||
| FaxNumber: | 5592218101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 09/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARZA | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5592218100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.