Provider Demographics
NPI:1083033849
Name:BIG PICTURE HIGH SCHOOL
Entity Type:Organization
Organization Name:BIG PICTURE HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-981-2143
Mailing Address - Street 1:1207 S TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706
Mailing Address - Country:US
Mailing Address - Phone:559-981-2143
Mailing Address - Fax:
Practice Address - Street 1:1207 S TRINITY ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2611
Practice Address - Country:US
Practice Address - Phone:559-981-2143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUNAMIS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100091AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962637512OtherMEDI CAL