Provider Demographics
NPI:1194001941
Name:EL CONCILIO
Entity Type:Organization
Organization Name:EL CONCILIO
Other - Org Name:LATINO BEHAVIOR HEALTH & RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MSW INTERN
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:AYALA-BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-444-8910
Mailing Address - Street 1:1755 W HAMMER LN STE 8
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2900
Mailing Address - Country:US
Mailing Address - Phone:209-444-8910
Mailing Address - Fax:209-444-8905
Practice Address - Street 1:1755 W HAMMER LN STE 8
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2900
Practice Address - Country:US
Practice Address - Phone:209-444-8910
Practice Address - Fax:209-444-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health