Provider Demographics
NPI:1407064843
Name:UNIVERSAL HEALTH NETWORK AND SYSTEMS, INC.
Entity Type:Organization
Organization Name:UNIVERSAL HEALTH NETWORK AND SYSTEMS, INC.
Other - Org Name:UNIVERSAL HEALTH NETWORK AND SYSTEMS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZENWUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:559-252-5150
Mailing Address - Street 1:3170 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1608
Mailing Address - Country:US
Mailing Address - Phone:559-252-5150
Mailing Address - Fax:559-252-5156
Practice Address - Street 1:3170 N CHESTNUT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-252-5150
Practice Address - Fax:559-252-5156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH NETWORK AND SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1082Medicaid