Healthcare Provider Details

I. General information

NPI: 1285371237
Provider Name (Legal Business Name): PREMIER VALLEY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 W SHAW AVE STE 102
FRESNO CA
93722-6232
US

IV. Provider business mailing address

4650 N PALM AVE
FRESNO CA
93704-3035
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-8000
  • Fax:
Mailing address:
  • Phone: 559-779-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TASNEEM A CHAUDHRY
Title or Position: CEO
Credential:
Phone: 559-779-8000