Provider Demographics
NPI:1033269543
Name:VALLEY STAR BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:VALLEY STAR BEHAVIORAL HEALTH, INC.
Other - Org Name:VALLEY STAR COMMUNITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-221-6336
Mailing Address - Street 1:1585 SOUTH D STREET
Mailing Address - Street 2:SUITE 101, 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3257
Mailing Address - Country:US
Mailing Address - Phone:909-388-2222
Mailing Address - Fax:
Practice Address - Street 1:1585 SOUTH D STREET
Practice Address - Street 2:SUITE 101, 205
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3257
Practice Address - Country:US
Practice Address - Phone:909-388-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA204511OtherCITY OF S.B. BIZ LIC.
CA36CLOtherSAN BERNARDINO CTY PROV #
CA2403428OtherSTATE CORP. #