Healthcare Provider Details

I. General information

NPI: 1922478734
Provider Name (Legal Business Name): EMINENCE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13883 S LASSEN AVE ROOMS 1 & 2
HELM CA
93627-9900
US

IV. Provider business mailing address

PO BOX 27707
FRESNO CA
93729-7707
US

V. Phone/Fax

Practice location:
  • Phone: 559-917-1635
  • Fax:
Mailing address:
  • Phone: 559-221-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUAN GARZA II
Title or Position: CEO
Credential:
Phone: 559-221-8100