Provider Demographics
NPI:1629668835
Name:TULARE CBAS, INC
Entity Type:Organization
Organization Name:TULARE CBAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYAMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-823-0014
Mailing Address - Street 1:8374 N FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9520
Mailing Address - Country:US
Mailing Address - Phone:818-823-0014
Mailing Address - Fax:
Practice Address - Street 1:1504-1534 PROSPERITY AVENUE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93724-9361
Practice Address - Country:US
Practice Address - Phone:818-823-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care