Healthcare Provider Details

I. General information

NPI: 1801547971
Provider Name (Legal Business Name): BLACK ENTERPRISES HEALTHCARE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CALAVERAS ST
FRESNO CA
93721-1103
US

IV. Provider business mailing address

1133 S ST
FRESNO CA
93721-1408
US

V. Phone/Fax

Practice location:
  • Phone: 559-790-1905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: SHANTAY R DAVIES-BALCH
Title or Position: OWNER
Credential:
Phone: 559-790-1905