Basic Information
| Provider Information | |||||||||
| NPI: | 1912159344 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRESNO COUNTY BEHAVIORAL HEALTH | ||||||||
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| OtherOrganizationName: | PSYCHIATRIC HEALTH FACILITY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3533 N PLEASANT AVE | ||||||||
| Address2: | APT. H | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937053037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597768652 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4411 E KINGS CANYON RD | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937023604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594534260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAGEE | ||||||||
| AuthorizedOfficialFirstName: | GWENDOLYN | ||||||||
| AuthorizedOfficialMiddleName: | YVETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH WORKER | ||||||||
| AuthorizedOfficialTelephone: | 5597768652 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.