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General NPI Number Information
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NPI Number | 1114129814
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Entity Type | Organization
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Legal Business Name | ADDICTION INTERVENTION RESOURCES
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 405 N BROADWAY ST
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City | FRESNO
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State | CA
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Zip | 93701-1513
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Country | US
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Telephone | 559-486-3146
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Fax | 559-486-3146
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Provider Business Mailing Address
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Address Line | 405 N BROADWAY ST
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City | FRESNO
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State | CA
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Zip | 93701-1513
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Country | US
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Telephone | 559-486-3146
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Fax | 559-486-3146
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LINDA GIBSON
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Credential |
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Telephone | 559-486-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 1006
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License Number State | CA
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