Healthcare Provider Details

I. General information

NPI: 1003530585
Provider Name (Legal Business Name): FRESNO NEW CREATION MINISTRIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 N 6TH ST STE 132
FRESNO CA
93710-7522
US

IV. Provider business mailing address

PO BOX 5451
FRESNO CA
93755-5451
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-1066
  • Fax:
Mailing address:
  • Phone: 559-227-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MANZIE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-770-9745