Provider Demographics
NPI:1750899316
Name:COUNTY OF FRESNO
Entity type:Organization
Organization Name:COUNTY OF FRESNO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-9193
Mailing Address - Street 1:3133 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1425
Mailing Address - Country:US
Mailing Address - Phone:559-600-4618
Mailing Address - Fax:
Practice Address - Street 1:1925 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4821
Practice Address - Country:US
Practice Address - Phone:559-600-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRESNO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)