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General NPI Number Information
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NPI Number | 1346877594
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Entity Type | Organization
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Legal Business Name | 2ND HOME INCORPORATED
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 07/11/2020
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Provider Practice Location Address
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Address Line | 3239 E TENAYA WAY
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City | FRESNO
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State | CA
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Zip | 93710-5924
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Country | US
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Telephone | 559-790-2271
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Fax | 559-321-8367
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Provider Business Mailing Address
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Address Line | 1187 N. WILLOW AVE. STE 103, #22
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City | CLOVIS
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State | CA
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Zip | 93611-4411
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Country | US
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Telephone | 559-790-2271
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Fax | 559-321-8367
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Authorized Official
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Title or Position | DIRECTOR
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Name | JENNIFER FISH
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Credential |
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Telephone | 559-790-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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