Healthcare Provider Details

I. General information

NPI: 1871347989
Provider Name (Legal Business Name): GENERATION CHANGERS TITLE 1 COMMUNITY DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FRESNO ST
FRESNO CA
93706-3115
US

IV. Provider business mailing address

740 FRESNO ST
FRESNO CA
93706-3115
US

V. Phone/Fax

Practice location:
  • Phone: 559-237-9066
  • Fax: 559-237-9006
Mailing address:
  • Phone: 559-307-0850
  • Fax: 559-237-9006

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
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON RODNEY SPENCER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-307-0850