Healthcare Provider Details

I. General information

NPI: 1396360855
Provider Name (Legal Business Name): NORTH STAR WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N. FRESNO STREET #103
FRESNO CA
93710
US

IV. Provider business mailing address

6051 N. FRESNO STREET #103
FRESNO CA
93710
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-2273
  • Fax: 559-226-2127
Mailing address:
  • Phone: 559-226-2273
  • Fax: 559-226-2127

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY D. DELA TORRE
Title or Position: CEO
Credential:
Phone: 559-226-2273