Provider Demographics
NPI:1326406216
Name:CLOVIS COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:CLOVIS COMMUNITY COLLEGE
Other - Org Name:STUDENT HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-325-5238
Mailing Address - Street 1:10309 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5401
Mailing Address - Country:US
Mailing Address - Phone:559-325-5200
Mailing Address - Fax:
Practice Address - Street 1:10309 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5401
Practice Address - Country:US
Practice Address - Phone:559-325-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE CENTER COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)