1427461136 NPI number — CENTRAL STAR BEHAVIORAL HEALTH, INC.

Table of content: (NPI 1427461136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427461136 NPI number — CENTRAL STAR BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL STAR BEHAVIORAL HEALTH, INC.
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:
CENTRAL STAR PSYCHIATRIC HEALTH FACILITY
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:
1427461136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 HUGHES WAY
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90810-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-221-6336
Provider Business Mailing Address Fax Number:
408-284-9050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 EAST KINGS CANYON ROAD
Provider Second Line Business Practice Location Address:
BLDG. 319
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93702-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-284-9012
Provider Business Practice Location Address Fax Number:
408-284-9050
Provider Enumeration Date:
06/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DUNLAP
Authorized Official First Name:
KENT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
310-221-6336

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  TBD , 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)





Copyright © 2007-2024 www.npivalidator.com