Healthcare Provider Details

I. General information

NPI: 1255204343
Provider Name (Legal Business Name): CENTRAL VALLEY JUSTICE COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 P ST STE 12
FRESNO CA
93721-2738
US

IV. Provider business mailing address

764 P ST STE 12
FRESNO CA
93721-2738
US

V. Phone/Fax

Practice location:
  • Phone: 559-216-6694
  • Fax:
Mailing address:
  • Phone: 559-216-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA WIENS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 559-725-1865