1912347741 NPI number — CLOVIS HYBRID AUTISM PROGRAM (CHAPS)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912347741 NPI number — CLOVIS HYBRID AUTISM PROGRAM (CHAPS)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLOVIS HYBRID AUTISM PROGRAM (CHAPS)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912347741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 N SUNNYSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93611-8171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-327-8400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
965 N SUNNYSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611-8171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-327-8400
Provider Business Practice Location Address Fax Number:
559-327-8179
Provider Enumeration Date:
06/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
559-327-9434

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  #PSY12625 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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