Healthcare Provider Details

I. General information

NPI: 1700166329
Provider Name (Legal Business Name): COMPREHENSIVE ADDICTIONS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W WHITES BRIDGE AVE
FRESNO CA
93706-1225
US

IV. Provider business mailing address

2445 W WHITES BRIDGE AVE
FRESNO CA
93706-1225
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2551
  • Fax: 559-264-6029
Mailing address:
  • Phone: 559-264-2551
  • Fax: 559-264-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number02-106820
License Number StateCA

VIII. Authorized Official

Name: JUANITO FIORELLO
Title or Position: DIRECTOR
Credential:
Phone: 559-264-2551