Provider Demographics
NPI:1760940951
Name:CENTRAL VALLEY WELLNESS CENTER
Entity Type:Organization
Organization Name:CENTRAL VALLEY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITINY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-449-3419
Mailing Address - Street 1:1478 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3607
Mailing Address - Country:US
Mailing Address - Phone:559-449-3419
Mailing Address - Fax:877-396-3157
Practice Address - Street 1:1478 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3607
Practice Address - Country:US
Practice Address - Phone:559-449-3419
Practice Address - Fax:877-396-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health