Provider Demographics
NPI:1316165582
Name:ADHC OF FRESNO & CLOVIS
Entity type:Organization
Organization Name:ADHC OF FRESNO & CLOVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-227-8600
Mailing Address - Street 1:3202 E ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3502
Mailing Address - Country:US
Mailing Address - Phone:559-227-8600
Mailing Address - Fax:559-227-8200
Practice Address - Street 1:3202 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3502
Practice Address - Country:US
Practice Address - Phone:559-227-8600
Practice Address - Fax:559-227-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70386FOtherMEDI-CAL