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General NPI Number Information
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NPI Number | 1255602066
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Entity Type | Organization
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Legal Business Name | SYNCHRONY OF VISALIA
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 1041 N DEMAREE ST
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City | VISALIA
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State | CA
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Zip | 93291-4119
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Country | US
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Telephone | 559-635-4252
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Fax | 559-635-4281
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Provider Business Mailing Address
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Address Line | 1041 N DEMAREE ST
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City | VISALIA
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State | CA
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Zip | 93291-4119
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Country | US
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Telephone | 559-635-4252
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Fax | 559-635-4281
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. EDWYN W ORTIZ-NANCE
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Credential | PSYD.
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Telephone | 559-635-4252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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