Organization
EMINENCE HEALTHCARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN GARZA II (COO/PROGRAM DIRECTOR)
(559) 221-8100
Entity
Organization
Contact information
Practice address
6240 W PALO ALTO AVE, RM 201, 301, 801-805, FRESNO, CA 93722-2001
(559) 221-8100
(559) 221-8101
Mailing address
PO BOX 27707, FRESNO, CA 93729-7707
(559) 221-8100
(559) 221-8101
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101076
MEDI-CAL
CA
Enumeration date
09/09/2008
Last updated
01/28/2015
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