CALIFORNIA IMPACT SERVICES (NPI# 1134777071) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134777071 |
| Entity Type | Organization |
| Organization Name | CALIFORNIA IMPACT SERVICES |
| Practice Address |
1616 W Shaw Ave Ste B4 Fresno CA 93711-3513 |
| Mailing Address |
1616 W Shaw Ave Ste B Fresno CA 93711-3513 |
| Practice Telephone | 5594583947 |
| Mailing Telephone | 5594583947 |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |
| Authorized Official Name | JOSHUA MCWEALTH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5594583947 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251T00000X | PACE Provider Organization | Agencies |
| Street Address |
1616 W SHAW AVE STE B4 |
| City | FRESNO |
| State | CA |
| Zip Code | 93711-3513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306181532 | Jennifer Marie Nickel | Counselor | 1616 W Shaw Ave Ste B4, Fresno, CA 93711-3513 | 2012-11-28 |
| 1538661558 | Medilogistics LLC | Non-emergency Medical Transport (VAN) | 1616 W Shaw Ave Ste B4, Fresno, CA 93711-3513 | 2018-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104464684 | Kazi Shafiul Moula | Dentist | Western Dental/ Brident 150bfo, 3077 W Shaw Ave, Fresno, CA 93711 | 2019-12-16 |
| 1760037063 | Armine Petrosyan | Nurse Practitioner | 427 W Beford Ave Suite 103, Fresno, CA 93711 | 2019-08-05 |
| 1912489360 | Shoua Nelson | Nurse Practitioner | 2490 W. Shaw Avenue Suite 101, Fresno, CA 93711 | 2018-09-02 |
| 1245725506 | Promesa Behavioral Health-barstow | Community Based Residential Treatment Facility, Mental Illness | 1415 W Barstow Ave, Fresno, CA 93711 | 2018-06-28 |
| 1407344138 | Aidan Mechem | Behavior Technician | 5140 N. Fruit Avene, Fresno, CA 93711 | 2018-04-27 |
| 1841798840 | Michael Ramos IIi | Behavior Technician | 1690 N Shaw Ave, 102, Fresno, CA 93711 | 2018-01-25 |
| 1962913467 | Dhara Devendrakumar Patel | Pharmacist | 740 West Alluvial Avenue, Suite 101, Fresno, CA 93711 | 2017-10-24 |
| 1588183636 | Bianca Arteaga | Counselor | 7485 N. Palm Ave., Suite 103, Fresno, CA 93711 | 2017-09-10 |
| 1346763158 | Powell Pediatric Dentistry Ingram Partnership | Dentist | 7761 N Ingram Ave, Suite 101, Fresno, CA 93711 | 2017-07-24 |
| 1982124202 | Justine Syera Balbas | Counselor | 2766 W. Celeste Ave., Unit 103, Fresno, CA 93711 | 2017-06-27 |
| Find all providers in zip 93711 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063988384 | Sequoia Pace, LLC. | PACE Provider Organization | 1649 Van Ness Ave, Fresno, CA 93721-1128 | 2018-10-15 |
| 1326668823 | Innovative Integrated Health Inc | PACE Provider Organization | 2042 Kern St, Fresno, CA 93721-2008 | 2020-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871191932 | One Family Health Enterprise | PACE Provider Organization | 206 E 185th St, Carson, CA 90746-1706 | 2020-10-12 |
| 1003445073 | North East Medical Services | PACE Provider Organization | 728 Pacific Ave Ste 201, San Francisco, CA 94133-4449 | 2020-04-02 |
| 1508422775 | Tri Starr Home Care LLC | PACE Provider Organization | 1669 Flanigan Dr., Unit H, San Jose, CA 95121 | 2019-05-14 |
| 1669037362 | Medrev | PACE Provider Organization | 558 Chelsea Way, Corona, CA 92879-5880 | 2019-05-08 |
| 1164980439 | Tri Starr Home Care, LLC | PACE Provider Organization | 1609 Flanigan Dr., Unit H, Unit H, San Jose, CA 95122 | 2019-03-06 |
| 1457838955 | La Coast Pace, LLC | PACE Provider Organization | 1220 E 4th St, Long Beach, CA 90802-1831 | 2018-07-26 |
| 1194202697 | Pacific Pace, LLC | PACE Provider Organization | 50 Alessandro Pl Ste A20, Pasadena, CA 91105-3149 | 2018-07-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1063901767 | Humboldt Mobile Massage, Inc | PACE Provider Organization | 1737 Margaret Ln, Arcata, CA 95521-6838 | 2018-05-08 |
| 1669986410 | Vast Oceanside Elderly Care | PACE Provider Organization | 452 Foussat Rd, Oceanside, CA 92054-4709 | 2017-11-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.