| Kermit Koontz Education Center | |
|
2822 E Floradora Ave Fresno CA 93703-3906 | |
| (559) 981-2143 | |
| Not Available |
| Full Name | Kermit Koontz Education Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2822 E Floradora Ave, Fresno, California |
| Authorized Official Name and Position | Orlando Gillam (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5599812143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kermit Koontz Education Center 2822 E Floradora Ave Fresno CA 93703-3906 Ph: (559) 981-2143 | Kermit Koontz Education Center 2822 E Floradora Ave Fresno CA 93703-3906 Ph: (559) 981-2143 |
| NPI Number | 1356760110 |
|---|---|
| Provider Enumeration Date | 04/09/2014 |
| Last Update Date | 04/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356760110 | NPI | - | NPPES |
| 1962637512 | Other | CA | MEDI CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 100091AN (California) | Primary |
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