Organization
COUNTY OF FRESNO
Active
Other names
Department of Public Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID POMAVILLE M.B.A., R.E.H.S. (DIRECTOR)
(559) 600-3200
Entity
Organization
Contact information
Practice address
5250 E CHURCH AVE, FRESNO, CA 93725-0900
(559) 253-6531
(559) 253-0255
Mailing address
PO BOX 11867, CMS-STOREY, 2ND FLOOR, FRESNO, CA 93775-1867
(559) 600-3300
(559) 600-7713
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCS00091F
MEDI-CAL
CA
Enumeration date
10/13/2006
Last updated
05/15/2014
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