Provider Demographics
NPI:1700925914
Name:FRESNO COUNTY SELMA REGIONAL CENTER
Entity Type:Organization
Organization Name:FRESNO COUNTY SELMA REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FRESNO CO MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GIANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-253-9180
Mailing Address - Street 1:4441 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3604
Mailing Address - Country:US
Mailing Address - Phone:559-253-9180
Mailing Address - Fax:
Practice Address - Street 1:3800 MCCALL AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2217
Practice Address - Country:US
Practice Address - Phone:559-875-7705
Practice Address - Fax:559-875-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1845OtherCOST CENTER
CAZZZ82027ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER