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General NPI Number Information
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NPI Number | 1508410341
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Entity Type | Organization
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Legal Business Name | FRESNO YOUTH CARE HOMES, INC.
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 1640 W SHAW AVE STE 100
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City | FRESNO
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State | CA
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Zip | 93711-3506
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Country | US
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Telephone | 559-840-1472
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Fax | 559-294-5946
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Provider Business Mailing Address
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Address Line | 2437 SANTA ANA AVE
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City | CLOVIS
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State | CA
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Zip | 93611-6533
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Country | US
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Telephone | 559-917-3443
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GLORETA JOHNSON
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Credential |
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Telephone | 559-917-3443
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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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