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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
COREEN CAMPOS (CHIEF EXECUTIVE OFFICER)
(559) 600-4961
Entity
Organization

Contact information

Practice address
732 N. VAN NESS AVE, FRESNO, CA 93728
(559) 237-3101
(559) 600-4895
Mailing address
3333 E. AMERICAN AVE SUITE B, FRESNO, CA 93725
(559) 600-4961
(559) 600-4895

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251K00000X
Public Health or Welfare Agency
251S00000X
Community/Behavioral Health Agency
Primary
251X00000X
Supports Brokerage Agency
320800000X
Mental Illness Community Based Residential Treatment Facility
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
324500000X
Substance Abuse Rehabilitation Facility
347E00000X
Transportation Broker

Other

Enumeration date
06/05/2018
Last updated
06/05/2018
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