Provider Demographics
NPI:1184049793
Name:GREATER FRESNO HEALTH ORGANIZATION INC.
Entity type:Organization
Organization Name:GREATER FRESNO HEALTH ORGANIZATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUANOUTOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-255-6476
Mailing Address - Street 1:4011 N MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4555
Mailing Address - Country:US
Mailing Address - Phone:559-860-4925
Mailing Address - Fax:
Practice Address - Street 1:4011 N MARKS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4555
Practice Address - Country:US
Practice Address - Phone:559-860-4925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center