Provider Demographics
NPI:1982972469
Name:FRESNO KINGS MADERA REGIONAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:FRESNO KINGS MADERA REGIONAL HEALTH AUTHORITY
Other - Org Name:CALVIVA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-445-8732
Mailing Address - Street 1:1315 VAN NESS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1727
Mailing Address - Country:US
Mailing Address - Phone:559-445-8735
Mailing Address - Fax:
Practice Address - Street 1:1315 VAN NESS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1727
Practice Address - Country:US
Practice Address - Phone:559-445-8735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933-0484302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization