Provider Demographics
NPI:1871347989
Name:GENERATION CHANGERS TITLE 1 COMMUNITY DEVELOPMENT CENTER
Entity type:Organization
Organization Name:GENERATION CHANGERS TITLE 1 COMMUNITY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-307-0850
Mailing Address - Street 1:740 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3115
Mailing Address - Country:US
Mailing Address - Phone:559-307-0850
Mailing Address - Fax:559-237-9006
Practice Address - Street 1:740 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3115
Practice Address - Country:US
Practice Address - Phone:559-237-9066
Practice Address - Fax:559-237-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder