Provider Demographics
NPI:1962184036
Name:FWDIOP INC
Entity type:Organization
Organization Name:FWDIOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-355-0089
Mailing Address - Street 1:1111 E HERNDON AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3100
Mailing Address - Country:US
Mailing Address - Phone:559-355-0089
Mailing Address - Fax:559-575-8176
Practice Address - Street 1:2880 E FREMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4809
Practice Address - Country:US
Practice Address - Phone:559-355-0089
Practice Address - Fax:559-575-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility