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General NPI Number Information
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NPI Number | 1841502655
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Entity Type | Organization
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Legal Business Name | MEDINA RESIDENTICAL CARE SERVICES
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1568 N MILLBROOK AVE
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City | FRESNO
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State | CA
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Zip | 93703-4149
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Country | US
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Telephone | 559-392-7291
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Fax | 559-840-1714
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Provider Business Mailing Address
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Address Line | 1568 N MILLBROOK AVE
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City | FRESNO
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State | CA
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Zip | 93703-4149
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Country | US
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Telephone | 559-392-7291
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Fax | 559-840-1714
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Authorized Official
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Title or Position | OWNER
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Name | MYSTI MEDINA
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Credential |
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Telephone | 559-392-7291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 107202360
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 107203232
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License Number State | CA
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 107202360
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License Number State | CA
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