Provider Demographics
NPI:1669596045
Name:AVANTE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:AVANTE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOURDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-261-9060
Mailing Address - Street 1:1111 E HERNDON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-261-9060
Mailing Address - Fax:559-261-9073
Practice Address - Street 1:1111 E HERNDON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-261-9060
Practice Address - Fax:559-261-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization