Provider Demographics
NPI:1437641479
Name:SPIRIT OF WOMAN OF CA, INC.
Entity Type:Organization
Organization Name:SPIRIT OF WOMAN OF CA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-233-4353
Mailing Address - Street 1:327 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2801
Mailing Address - Country:US
Mailing Address - Phone:559-233-4353
Mailing Address - Fax:559-233-4344
Practice Address - Street 1:327 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2801
Practice Address - Country:US
Practice Address - Phone:559-233-4353
Practice Address - Fax:559-233-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder