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General NPI Number Information
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NPI Number | 1144809161
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Entity Type | Organization
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Legal Business Name | POVERELLO HOUSE
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 412 F ST
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City | FRESNO
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State | CA
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Zip | 93706-3409
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Country | US
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Telephone | 559-498-6988
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Fax |
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Provider Business Mailing Address
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Address Line | 412 F ST
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City | FRESNO
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State | CA
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Zip | 93706-3409
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Country | US
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Telephone | 559-498-6988
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MENTAL HEALTH SERVICES
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Name | MR. XAINYAVONG VANG
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Credential | LPCC 16877
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Telephone | 559-498-6988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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