MEDICARE: PROJECT 14:14 INC.

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1942023585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT 14:14 INC.

Provider Business Mailing Address
First Line	:	1222 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3706
Country	:	US
Telephone Number	:	559-705-8674
Fax Number	:

Provider Business Practice Location Address
First Line	:	7328 N FRUIT AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-0717
Country	:	US
Telephone Number	:	559-705-8674
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHASTITY DAY
Credential	:
Telephone Number	:	559-705-8674

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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Directions to “PROJECT 14:14 INC. ” Practice Location

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