Organization
START FRESH CENTRAL VALLEY RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GRAHAM M.D. (SUPERVISING PHYSICIAN)
(559) 202-3830
Entity
Organization
Contact information
Practice address
6073 N 1ST ST STE 102, FRESNO, CA 93710-5444
(559) 202-3830
Mailing address
PO BOX 25042, FRESNO, CA 93729-5042
(559) 438-1245
(559) 892-4500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Enumeration date
07/29/2014
Last updated
07/29/2014
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