Healthcare Provider Details

I. General information

NPI: 1982999280
Provider Name (Legal Business Name): GENERATIONAL CHANGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 FRESNO ST
FRESNO CA
93706-3117
US

IV. Provider business mailing address

1313 P ST STE 200
FRESNO CA
93721-1827
US

V. Phone/Fax

Practice location:
  • Phone: 559-681-0533
  • Fax: 559-681-0533
Mailing address:
  • Phone: 559-681-0533
  • Fax: 559-230-3093

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: MS. LINDA V WASHINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-681-0533