№ lp_2_3_49788
Administrative application and attestation form for organizational providers seeking re-credentialing within the Fresno County Behavioral Health System of Care, detailing identification, licensure, employment history, qualifications, and compliance declarations.
Organization: Fresno County Behavioral Health System of Care
Department: Plan Administration Credentialing
Document Type: Organizational re-credentialing application and questionnaire
Submission Date: 5/29/2025
Region: Fresno County, California
Country: United States
Address (Hand Delivery): 1925 E. Dakota Avenue, M/S 271, Fresno, CA 93726
Address (Mail): P.O. Box 45003, Fresno, CA 93718-9886
Contact Email: [email protected]
Contact Phone: 559-600-4645
Contact Fax: 559-455-4633
Applicable To: Licensed, unlicensed, waivered, certified or registered staff and organizational providers
Regulatory Basis: Approval based on regulatory requirements
Non-Discrimination Statement: Equal opportunity, disabilities, affirmative action organization; non-discrimination under Federal and State law
Sections: Organizational Information; Applicant Information; NPI and Taxonomy; Employment/Work History; Professional Education; Provider Numbers; Board Certifications; Hospital Privileges; Professional Historical Data Attestation
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

Don’t have cryptocurrency yet?

You can still complete your purchase in a few minutes:
  1. Buy Crypto in a trusted app (Coinbase, Kraken, Cash App or any similar service).
  2. In the app, tap Send.
  3. Select network, paste our wallet address.
  4. Send the exact amount shown above.
After sending, paste your TXID (transaction ID) and your email to receive the download link. Need help? Contact support and we’ll guide you step by step.