Healthcare Provider Details

I. General information

NPI: 1033493713
Provider Name (Legal Business Name): JUST4KIDZINC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 W SUSSEX WAY
FRESNO CA
93705-2021
US

IV. Provider business mailing address

11 S TEILMAN AVE
FRESNO CA
93706-1332
US

V. Phone/Fax

Practice location:
  • Phone: 281-782-5887
  • Fax:
Mailing address:
  • Phone: 281-078-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE TAYLER
Title or Position: CEO
Credential:
Phone: 559-389-3963