Provider Demographics
NPI:1922375104
Name:DUNAMIS,INC GROUP HOME
Entity Type:Organization
Organization Name:DUNAMIS,INC GROUP HOME
Other - Org Name:DUNAMIS.INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLAM
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:281-782-5887
Mailing Address - Street 1:823WSUSSEXWAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705
Mailing Address - Country:US
Mailing Address - Phone:281-782-5887
Mailing Address - Fax:
Practice Address - Street 1:1019 S PEACH AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4889
Practice Address - Country:US
Practice Address - Phone:281-782-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health