1609384940 NPI number — FAMILY HEALTHCARE NETWORK

Table of content: (NPI 1609384940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609384940 NPI number — FAMILY HEALTHCARE NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTHCARE NETWORK
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:
1609384940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 E CENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-737-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 N HERWALDT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93701-2186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-737-4700
Provider Business Practice Location Address Fax Number:
559-734-1247
Provider Enumeration Date:
01/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HYDASH
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
559-737-4700

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 921088 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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