Organization
EMINENCE HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN GARZA II (CEO/PROGRAM DIRECTOR)
(559) 221-8100
Entity
Organization
Contact information
Practice address
11 S TEILMAN AVE, RM 1, 2, 5, 12-18, FRESNO, CA 93706-1332
(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
11/20/2007
Last updated
09/21/2017
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