Provider Demographics
NPI:1780856518
Name:FRESNO COUNTY ACTTC MAA/TCM PROGRAM
Entity Type:Organization
Organization Name:FRESNO COUNTY ACTTC MAA/TCM PROGRAM
Other - Org Name:FRESNO COUNTY ACTTC
Other - Org Type:Other Name
Authorized Official - Title/Position:MAA/TCM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-1431
Mailing Address - Street 1:2281 TULARE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2134
Mailing Address - Country:US
Mailing Address - Phone:559-600-3496
Mailing Address - Fax:559-600-1447
Practice Address - Street 1:2281 TULARE ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2134
Practice Address - Country:US
Practice Address - Phone:559-600-3496
Practice Address - Fax:559-600-1447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRESNO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management