Healthcare Provider Details

I. General information

NPI: 1891260576
Provider Name (Legal Business Name): SIERRA MEADOWS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 E FIR AVE STE 102
FRESNO CA
93720-3865
US

IV. Provider business mailing address

1781 E FIR AVE STE 102
FRESNO CA
93720-3865
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW THOMAS TATUM
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 559-593-9801