Provider Demographics
NPI:1346877594
Name:2ND HOME INCORPORATED
Entity Type:Organization
Organization Name:2ND HOME INCORPORATED
Other - Org Name:2ND HOME, INC.-TENAYA FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-790-2271
Mailing Address - Street 1:1187 N. WILLOW AVE. STE 103, #22
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4411
Mailing Address - Country:US
Mailing Address - Phone:559-790-2271
Mailing Address - Fax:559-321-8367
Practice Address - Street 1:3239 E TENAYA WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5924
Practice Address - Country:US
Practice Address - Phone:559-790-2271
Practice Address - Fax:559-321-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness