Healthcare Provider Details

I. General information

NPI: 1770706657
Provider Name (Legal Business Name): EMINENCE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 NELSON BLVD ROOM 110 & 111
SELMA CA
93662-4524
US

IV. Provider business mailing address

PO BOX 27707
FRESNO CA
93729-7707
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8101
Mailing address:
  • Phone: 559-221-8100
  • Fax: 559-221-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN GARZA II
Title or Position: COO/PROGRAM DIRECTOR
Credential:
Phone: 559-221-8100