Provider Demographics
NPI:1841612587
Name:DEPARTMENT OF BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:
Authorized Official - First Name:DAINNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-3550
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3550
Mailing Address - Fax:
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-600-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FRESNO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN242638310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness