Healthcare Provider Details

I. General information

NPI: 1023824802
Provider Name (Legal Business Name): LIVE AGAIN FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W HEDGES AVE
FRESNO CA
93728-1219
US

IV. Provider business mailing address

1145 W HEDGES AVE
FRESNO CA
93728-1219
US

V. Phone/Fax

Practice location:
  • Phone: 559-294-1390
  • Fax:
Mailing address:
  • Phone: 559-294-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: JANESSA C WILLIAMS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 913-406-4569