Organization
MEDINA RESIDENTICAL CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYSTI MEDINA (OWNER)
(559) 392-7291
Entity
Organization
Contact information
Practice address
1568 N MILLBROOK AVE, FRESNO, CA 93703-4149
(559) 392-7291
(559) 840-1714
Mailing address
1568 N MILLBROOK AVE, FRESNO, CA 93703-4149
(559) 392-7291
(559) 840-1714
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
107202360
CA
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
107202360
CA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
107203232
CA
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
332U00000X
Home Delivered Meals
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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