| First Street Center Outpatient Sud | |
|
2212 N Winery Ave Ste 101 Fresno CA 93703-2896 | |
| (559) 225-1464 | |
| (559) 225-1693 |
| Full Name | First Street Center Outpatient Sud |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2212 N Winery Ave Ste 101, Fresno, California |
| Authorized Official Name and Position | Scott Charles Hollander (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5597328086 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| First Street Center Outpatient Sud 3636 N 1st St Ste 135 Fresno CA 93726-6818 Ph: (559) 225-1464 | First Street Center Outpatient Sud 2212 N Winery Ave Ste 101 Fresno CA 93703-2896 Ph: (559) 225-1464 |
| NPI Number | 1144676859 |
|---|---|
| Provider Enumeration Date | 05/11/2016 |
| Last Update Date | 05/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144676859 | NPI | - | NPPES |
| 10CM | Other | CA | DRUG MEDI-CAL |
| 100028HN | Other | CA | AOD CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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