Healthcare Provider Details

I. General information

NPI: 1518199215
Provider Name (Legal Business Name): JUST 4 KIDZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W SHAW AVE SWEET 101
FRESNO CA
93711-3234
US

IV. Provider business mailing address

605 W HERNDON AVE SUITE 600 #27
CLOVIS CA
93612-0191
US

V. Phone/Fax

Practice location:
  • Phone: 559-389-3963
  • Fax:
Mailing address:
  • Phone: 559-389-3963
  • 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 ALTON TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-389-3963