1265554042 NPI number — SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES

Table of content: (NPI 1265554042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265554042 NPI number — SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1265554042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2008
NPI Reactivation Date:
01/30/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 N CALIFORNIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95202-1552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-468-0651
Provider Business Mailing Address Fax Number:
209-468-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7233 SOUTH DELIVERY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231-9693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-6857
Provider Business Practice Location Address Fax Number:
209-468-6739
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTINE
Authorized Official First Name:
GENEVIEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR-BEHAVIORAL HEALTH SERVICES
Authorized Official Telephone Number:
209-468-8750

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  324500000 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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