Provider Demographics
NPI:1962724120
Name:EUREKA PROGRAM
Entity type:Organization
Organization Name:EUREKA PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-321-1309
Mailing Address - Street 1:PO BOX 2631
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93745-2631
Mailing Address - Country:US
Mailing Address - Phone:559-321-1309
Mailing Address - Fax:
Practice Address - Street 1:916 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3762
Practice Address - Country:US
Practice Address - Phone:559-321-1309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children