Provider Demographics
NPI:1558454256
Name:FAMILY HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-737-4731
Mailing Address - Street 1:305 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-734-1247
Practice Address - Street 1:41651 SIERRA DR STE A
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9678
Practice Address - Country:US
Practice Address - Phone:559-561-4683
Practice Address - Fax:559-561-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA120000647261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70917FMedicaid
CA55-1902Medicare ID - Type UnspecifiedMEDICARE FQHC