Provider Demographics
NPI:1215640651
Name:HAYWOOD, CHARLES EDWARD
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 W WRENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2939
Mailing Address - Country:US
Mailing Address - Phone:559-281-5438
Mailing Address - Fax:
Practice Address - Street 1:5714 W BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2616
Practice Address - Country:US
Practice Address - Phone:559-281-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit