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General NPI Number Information
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NPI Number | 1396371720
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Entity Type | Organization
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Legal Business Name | SIERRA MEADOWS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 2343 DEAUVILLE CIR
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City | CLOVIS
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State | CA
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Zip | 93619-4292
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Country | US
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Telephone | 559-326-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 1781 E FIR AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93720-3865
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW THOMAS TATUM
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Credential |
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Telephone | 559-567-3912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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