Provider Demographics
NPI:1821211707
Name:EMINENCE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:EMINENCE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-221-8100
Mailing Address - Street 1:7170 N. FINANCIAL DRIVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2978
Mailing Address - Country:US
Mailing Address - Phone:559-221-8100
Mailing Address - Fax:559-221-8101
Practice Address - Street 1:2025 N. GATEWAY BLVD. STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1619
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:559-221-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101076000OtherDRUG MEDI-CAL