Healthcare Provider Details

I. General information

NPI: 1912093451
Provider Name (Legal Business Name): FAMILY HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12586 AVENUE 408
OROSI CA
93647-9454
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 559-528-2804
  • Fax: 559-528-7623
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-734-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number120000651
License Number StateCA

VIII. Authorized Official

Name: MRS. KERRY HYDASH
Title or Position: PRESIDENT CEO
Credential:
Phone: 559-737-4731