Provider Demographics
NPI:1801986823
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:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POMAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, REHS
Authorized Official - Phone:559-600-3229
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CMS-CLOVIS, 2ND FLOOR
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3300
Mailing Address - Fax:559-600-7713
Practice Address - Street 1:1345 N PEACH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8342
Practice Address - Country:US
Practice Address - Phone:559-327-1910
Practice Address - Fax:559-327-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00119FOtherMEDI-CAL