Provider Demographics
NPI:1073705497
Name:MEDMARK TREATMENT CENTERS-FRESNO EAST, INC.
Entity Type:Organization
Organization Name:MEDMARK TREATMENT CENTERS-FRESNO EAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GECSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-925-1401
Mailing Address - Street 1:2 TRANSAM PLAZA DR
Mailing Address - Street 2:420
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4823
Mailing Address - Country:US
Mailing Address - Phone:630-925-1400
Mailing Address - Fax:630-925-1419
Practice Address - Street 1:5510 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4526
Practice Address - Country:US
Practice Address - Phone:559-264-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty