Healthcare Provider Details

I. General information

NPI: 1194035790
Provider Name (Legal Business Name): JUST 4 KIDZ,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 HELM AVE
CLOVIS CA
93612-4829
US

IV. Provider business mailing address

605 W HERNDON AVE SUITE 800 #27
CLOVIS CA
93612-0191
US

V. Phone/Fax

Practice location:
  • Phone: 559-389-3963
  • Fax:
Mailing address:
  • Phone: 559-389-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EUGENE ALTON TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-389-3963