Provider Demographics
NPI:1033648084
Name:O'CONNOR WOODS HOUSING CORP
Entity Type:Organization
Organization Name:O'CONNOR WOODS HOUSING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ADMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASIC
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:209-956-3484
Mailing Address - Street 1:3400 WAGNER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209
Mailing Address - Country:US
Mailing Address - Phone:209-476-4036
Mailing Address - Fax:209-476-4042
Practice Address - Street 1:3400 WAGNER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4843
Practice Address - Country:US
Practice Address - Phone:209-476-4036
Practice Address - Fax:209-476-4042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:O'CONNOR WOODS HOUSING CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health