Healthcare Provider Details

I. General information

NPI: 1104245489
Provider Name (Legal Business Name): DUNAMIS, INC. GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 N MAROA AVE
FRESNO CA
93728-1815
US

IV. Provider business mailing address

1509 N MAROA AVE
FRESNO CA
93728-1815
US

V. Phone/Fax

Practice location:
  • Phone: 559-441-1543
  • Fax:
Mailing address:
  • Phone: 559-441-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number100091AN
License Number StateCA

VIII. Authorized Official

Name: MR. ORLANDO GILLAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 559-981-2143