Organization
PROMESA BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WEIGANT MA (CEO)
(559) 439-5437
Entity
Organization
Contact information
Practice address
2815 G ST, MERCED, CA 95340-2133
(209) 725-3114
(209) 725-3114
Mailing address
7475 N PALM AVE STE 107, FRESNO, CA 93711-5763
(559) 439-5437
(559) 439-5411
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
1044
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1044
—
CA
Enumeration date
09/01/2011
Last updated
09/01/2011
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