Organization
FWDIOP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN TUCKER (PROGRAM DIRECTOR)
(559) 355-0089
Entity
Organization
Contact information
Practice address
2880 E FREMONT AVE, FRESNO, CA 93710-4809
(559) 355-0089
(559) 575-8176
Mailing address
1111 E HERNDON AVE STE 211, FRESNO, CA 93720-3100
(559) 355-0089
(559) 575-8176
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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