1215962782 NPI number — JOHN MUIR BEHAVIORAL HEALTH

Table of content: (NPI 1215962782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215962782 NPI number — JOHN MUIR BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN MUIR BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOHN MUIR BEHAVIORAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215962782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 TREAT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-939-3000
Provider Business Mailing Address Fax Number:
925-641-2236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-674-4100
Provider Business Practice Location Address Fax Number:
925-686-1087
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
CALVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official Telephone Number:
925-941-2100

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  14000G418 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZR34131F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061860 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 054131 . This is a "BX OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSM34131F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZH0700Z . This is a "BLUE SHIELD OF CALIF" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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