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General NPI Number Information
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NPI Number | 1790321412
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Entity Type | Organization
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Legal Business Name | MAJESTY HOLISTIC HEALTH SERVICES, LLP
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2906 VALIANT ELM ST
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City | FRESNO
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State | TX
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Zip | 77545-8160
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Country | US
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Telephone | 708-203-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 2906 VALIANT ELM ST
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City | FRESNO
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State | TX
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Zip | 77545-8160
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Country | US
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Telephone | 708-203-1830
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MRS. BRIDGET IKEJIMBA
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Credential | RN
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Telephone | 708-203-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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