Provider Demographics
NPI:1770912339
Name:FRESNO-MADERA AREA AGENCY ON AGING - MSSP
Entity type:Organization
Organization Name:FRESNO-MADERA AREA AGENCY ON AGING - MSSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-4405
Mailing Address - Street 1:3837 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4806
Mailing Address - Country:US
Mailing Address - Phone:559-600-4405
Mailing Address - Fax:559-243-5918
Practice Address - Street 1:3837 N CLARK ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4806
Practice Address - Country:US
Practice Address - Phone:559-600-4405
Practice Address - Fax:559-243-5918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESNO-MADERA AREA AGENCY ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-04
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management