Healthcare Provider Details

I. General information

NPI: 1821211707
Provider Name (Legal Business Name): EMINENCE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N. GATEWAY BLVD. STE 104
FRESNO CA
93727-1619
US

IV. Provider business mailing address

7170 N. FINANCIAL DRIVE SUITE 135
FRESNO CA
93720-2978
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8100
Mailing address:
  • Phone: 559-221-8100
  • Fax: 559-221-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DONNIE JOSEPH ANDRADE
Title or Position: CEO
Credential:
Phone: 559-221-8100