Provider Demographics
NPI:1639482557
Name:GOLDEN STATE FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:GOLDEN STATE FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-271-7769
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4285 N VALENTINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4148
Practice Address - Country:US
Practice Address - Phone:559-241-0955
Practice Address - Fax:559-241-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health