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General NPI Number Information
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NPI Number | 1164239299
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Entity Type | Organization
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Legal Business Name | HER HARBOR LLC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 6667 N VAN NESS BLVD
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City | FRESNO
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State | CA
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Zip | 93711-1249
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Country | US
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Telephone | 877-536-0845
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Fax |
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Provider Business Mailing Address
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Address Line | 7235 N KNOLL AVE
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City | FRESNO
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State | CA
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Zip | 93711-0622
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Country | US
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Telephone | 877-536-0845
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE JOHNS
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Credential |
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Telephone | 815-919-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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