Provider Demographics
NPI:1306223516
Name:VALLEY STAR BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:VALLEY STAR BEHAVIORAL HEALTH, INC.
Other - Org Name:VALLEY STAR CRISIS WALK-IN CENTER - MORONGO BASIN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-221-6336
Mailing Address - Street 1:1501 HUGHES WAY
Mailing Address - Street 2:150
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1878
Mailing Address - Country:US
Mailing Address - Phone:310-221-6336
Mailing Address - Fax:
Practice Address - Street 1:7293 DUMOSA AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3700
Practice Address - Country:US
Practice Address - Phone:760-353-2266
Practice Address - Fax:760-365-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health