Provider Demographics
NPI:1659124691
Name:ELENKA
Entity Type:Organization
Organization Name:ELENKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUCHARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-269-0416
Mailing Address - Street 1:3455 W SHAW AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3201
Mailing Address - Country:US
Mailing Address - Phone:559-515-6180
Mailing Address - Fax:
Practice Address - Street 1:3455 W SHAW AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3201
Practice Address - Country:US
Practice Address - Phone:559-515-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELENKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty