Healthcare Provider Details

I. General information

NPI: 1558769232
Provider Name (Legal Business Name): HOOVER HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 N 1ST ST
FRESNO CA
93710-6201
US

IV. Provider business mailing address

5550 N 1ST ST
FRESNO CA
93710-6201
US

V. Phone/Fax

Practice location:
  • Phone: 559-981-2143
  • Fax:
Mailing address:
  • Phone: 559-981-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100091AN
License Number StateCA

VIII. Authorized Official

Name: MR. ORLANDO GILLAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 559-981-2143