Provider Demographics
NPI:1790080067
Name:SAN JOAQUIN COUNTY - HSA - ACS
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY - HSA - ACS
Other - Org Name:AGING AND COMMUNITY SEVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALVEREZ
Authorized Official - Last Name:MAYORGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-1721
Mailing Address - Street 1:102 S SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3213
Mailing Address - Country:US
Mailing Address - Phone:209-465-8220
Mailing Address - Fax:209-468-2207
Practice Address - Street 1:102 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3213
Practice Address - Country:US
Practice Address - Phone:209-465-8220
Practice Address - Fax:209-468-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management