Healthcare Provider Details

I. General information

NPI: 1730851320
Provider Name (Legal Business Name): VALLEY TEEN RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10641 ROAD 35
MADERA CA
93636
US

IV. Provider business mailing address

2610 W SHAW LN STE 105
FRESNO CA
93711-2775
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-1444
  • Fax:
Mailing address:
  • Phone: 559-437-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MICHELE EVANS
Title or Position: CEO
Credential:
Phone: 559-437-1144