Healthcare Provider Details

I. General information

NPI: 1770912339
Provider Name (Legal Business Name): FRESNO-MADERA AREA AGENCY ON AGING - MSSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 W SHAW LN STE 101A
FRESNO CA
93711-2768
US

IV. Provider business mailing address

2520 W SHAW LN STE 101A
FRESNO CA
93711-2768
US

V. Phone/Fax

Practice location:
  • Phone: 559-214-0299
  • Fax: 559-243-5918
Mailing address:
  • Phone: 559-214-0299
  • Fax: 559-243-5918

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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMIE SHARMA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-219-0299