Greater Fresno Health Orgnization, Inc.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

040000336 Issued in CA

Legal business name

GREATER FRESNO HEALTH ORGNIZATION, INC.

Practice address

4929 E Kings Canyon Rd
Fresno, CA 93727-3812

Phone

(559) 255-6476

Fax

(559) 255-7906

NPI assigned

Oct 7, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bla Mouanoutoua

Title

Ceo

Phone

(559) 255-6476

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• KINGS WINERY MEDICLA CLINIC Doing business as

Tax ID family

Greater Fresno Health Orgnization Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Greater Fresno Health Organization Inc.

  • Clinic/Center
  • Fresno, CA
  • NPI 1184049793
  NPD tax ID
• Greater Fresno Health Organization, Inc.

  • Community Health Clinic/Center
  • Fresno, CA
  • NPI 1033627179
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vang Vince Moua, PA-C

  • Medical Physician Assistant
  • Fresno, CA
  • NPI 1164682100
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1154656254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4929 E KINGS CANYON RD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273812",
            "telephone_number": "559-255-6476",
            "fax_number": "559-255-7906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4929 E KINGS CANYON RD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273812",
            "telephone_number": "559-255-6476",
            "fax_number": "559-255-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER FRESNO HEALTH ORGNIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-07",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "MOUANOUTOUA",
        "authorized_official_first_name": "BLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-255-6476",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "040000336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP70517F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KINGS WINERY MEDICLA CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Greater Fresno Development Corp.
• Greater Fresno Development Corp.
• Greater Fresno Health Organization Inc.
• Greater Fresno Health Organization, Inc.
• Greater Fresno Health Organization, Inc.
• Mandy Michelle Greaves, PHD, LMFT
• Robert E Greco, CO
• Adriel J Green, MD
• Alvin E Green, LCSW
• Anjanetta P Green, LCSW

• Exclusive Provider Organization in Fresno, CA
• Providers in Fresno, CA by specialty
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.