Healthcare Provider Details

I. General information

NPI: 1104978022
Provider Name (Legal Business Name): FRESNO COUNTY APOLLO RESIDENTIAL PROG.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N BLACKSTONE AVE
FRESNO CA
93701-1914
US

IV. Provider business mailing address

205 N BLACKSTONE AVE
FRESNO CA
93701-1914
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-0241
  • Fax:
Mailing address:
  • Phone: 559-498-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: GIANG T NGUYEN
Title or Position: DIRECTOR, FRESNO CO MENTAL HEALTH
Credential:
Phone: 559-253-9180