Provider Demographics
NPI:1043920978
Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:S.J.C. MHSA CYS FOSTER YOUTH FSP INTAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-8887
Mailing Address - Street 1:333 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3200
Mailing Address - Country:US
Mailing Address - Phone:209-468-8750
Mailing Address - Fax:
Practice Address - Street 1:333 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3200
Practice Address - Country:US
Practice Address - Phone:209-468-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9096Medicaid