CHILDREN'S HOME OF STOCKTON NPI 1790265023

NPI Information

NPI: 1790265023
Provider Name: CHILDREN'S HOME OF STOCKTON
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
430 N PILGRIM ST
STOCKTON, CA
ZIP 95205
Phone: (209) 466-0853
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CHILDREN'S HOME OF STOCKTON is a residential treatment facility emotionally disturbed children in Stockton, CA. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. CHILDREN'S HOME OF STOCKTON NPI is 1790265023. The provider is registered as an organization entity type.

The provider's business location address is:

430 N PILGRIM ST
STOCKTON, CA
ZIP 95205-428
Phone: (209) 466-0853
Fax: (209) 466-6808

The provider's authorized official is Tici Renee Truly .
The authorized official title is Human Resources Director and has the following contact phone number (209) 466-0853.

The enumeration date for this NPI number is 8/16/2018 and was last updated on 8/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	397002552	CALIFORNIA	No
2	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	397002553	CALIFORNIA	No
3	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	397002554	CALIFORNIA	No
4	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	390300131	CALIFORNIA	No
5	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	390332238	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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