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General NPI Number Information
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NPI Number | 1164235388
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY COMMUNITY SPORTS FOUNDATION
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 4000 N CEDAR AVE
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City | FRESNO
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State | CA
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Zip | 93726-5267
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Country | US
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Telephone | 559-349-6965
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Fax | 707-703-5794
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Provider Business Mailing Address
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Address Line | 4266 N COLLEGE AVE
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City | FRESNO
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State | CA
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Zip | 93704-3844
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Country | US
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Telephone | 559-349-6965
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Fax | 707-703-5794
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERANCE FRAZIER
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Credential |
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Telephone | 559-349-6965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 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 #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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