| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 144 S. L St., Dinuba, California |
| Authorized Official Name and Position | Sharon Marie Ross (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5597328086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 7447 Visalia CA 93290-7447 Ph: (559) 732-8086 | 144 S. L St. Dinuba CA 93618 Ph: (559) 591-6680 |
| NPI Number | 1538299078 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 03/01/2021 |
| Certification Date | 03/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538299078 | NPI | - | NPPES |
| 5433 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |