Healthcare Provider Details

I. General information

NPI: 1538955893
Provider Name (Legal Business Name): HOME SHELTER COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 E ASHLAN AVE
FRESNO CA
93726-3102
US

IV. Provider business mailing address

2329 E ASHLAN AVE
FRESNO CA
93726-3102
US

V. Phone/Fax

Practice location:
  • Phone: 559-917-5336
  • Fax:
Mailing address:
  • Phone: 559-917-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GEVORK BOYADJIAN
Title or Position: CEO
Credential:
Phone: 559-917-5336