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General NPI Number Information
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NPI Number | 1841612587
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1221 FULTON MALL
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City | FRESNO
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State | CA
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Zip | 93721-1915
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Country | US
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Telephone | 559-600-3550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11867
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City | FRESNO
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State | CA
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Zip | 93775-1867
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Country | US
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Telephone | 559-600-3550
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | DAINNA LYNN DRIVER
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Credential |
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Telephone | 559-600-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | VN242638
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License Number State | CA
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