Provider Demographics
NPI:1518095488
Name:VIOLET HEINTZ EDUCATION ACADEMY
Entity Type:Organization
Organization Name:VIOLET HEINTZ EDUCATION ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIREC DEP BEH HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:DAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-6895
Mailing Address - Street 1:3133 N MILLBROOK
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1425
Mailing Address - Country:US
Mailing Address - Phone:559-453-8918
Mailing Address - Fax:
Practice Address - Street 1:4939 E YALE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727
Practice Address - Country:US
Practice Address - Phone:559-443-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRESNO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000001091261QM0855X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000001091Medicaid
2415OtherCOST CENTER