Provider Demographics
NPI:1619152634
Name:EMINENCE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:EMINENCE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:559-221-8100
Mailing Address - Street 1:PO BOX 27707
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7707
Mailing Address - Country:US
Mailing Address - Phone:559-221-8100
Mailing Address - Fax:559-221-8101
Practice Address - Street 1:3535 N CORNELIA AVE
Practice Address - Street 2:ROOMS 1101-07,1201-02,1206-10,1301-06,1313-16,1318-19
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-7020
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:559-221-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10-6210OtherMEDI-CAL