MEDICARE: DUNAMIS,INC GROUP HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1255616249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNAMIS,INC GROUP HOME

Provider Business Mailing Address
First Line	:	823 W SUSSEX WAY
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2021
Country	:	US
Telephone Number	:	281-782-5887
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 N PALM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1941
Country	:	US
Telephone Number	:	281-782-5887
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ORLANDO GILLAM II
Credential	:
Telephone Number	:	281-782-5887

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	10/21/2011

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Directions to “DUNAMIS,INC GROUP HOME ” Practice Location

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