Provider Demographics
NPI:1104978022
Name:FRESNO COUNTY APOLLO RESIDENTIAL PROG.
Entity type:Organization
Organization Name:FRESNO COUNTY APOLLO RESIDENTIAL PROG.
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 1:205 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1914
Mailing Address - Country:US
Mailing Address - Phone:559-498-0241
Mailing Address - Fax:
Practice Address - Street 1:205 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1914
Practice Address - Country:US
Practice Address - Phone:559-498-0241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2160OtherCOST CENTER
CAZZZ82027ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER