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General NPI Number Information
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NPI Number | 1861291445
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Entity Type | Organization
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Legal Business Name | VALLEY TEEN RANCH
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 2610 W SHAW LN STE 105
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City | FRESNO
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State | CA
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Zip | 93711-2775
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Country | US
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Telephone | 559-437-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 W SHAW LN STE 105
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City | FRESNO
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State | CA
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Zip | 93711-2775
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Country | US
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Telephone | 559-437-1144
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDREA MICHELE EVANS
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Credential |
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Telephone | 559-437-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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