Provider Demographics
NPI:1073868527
Name:AVENAL COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:AVENAL COMMUNITY HEALTH CENTER
Other - Org Name:ARIA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-386-4500
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:559-282-5080
Practice Address - Street 1:140 C ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2929
Practice Address - Country:US
Practice Address - Phone:559-924-7005
Practice Address - Fax:559-924-3197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVENAL COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001875261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
55-1177Medicare PIN
CA551177Medicare Oscar/Certification