Provider Demographics
NPI:1114243771
Name:MARY MAGDALENE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MARY MAGDALENE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL-SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-888-4519
Mailing Address - Street 1:445 N SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2003
Mailing Address - Country:US
Mailing Address - Phone:209-888-4519
Mailing Address - Fax:209-888-4536
Practice Address - Street 1:445 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2003
Practice Address - Country:US
Practice Address - Phone:209-888-4519
Practice Address - Fax:209-888-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health