Provider Demographics
NPI:1851427322
Name:COMMUNITY SERVICE ORGANIZATION BEHAVIORAL HEALTH PROGRAM
Entity Type:Organization
Organization Name:COMMUNITY SERVICE ORGANIZATION BEHAVIORAL HEALTH PROGRAM
Other - Org Name:BROTHERHOOD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GOTAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:ED
Authorized Official - Phone:661-327-0376
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389
Mailing Address - Country:US
Mailing Address - Phone:661-327-9376
Mailing Address - Fax:661-327-7649
Practice Address - Street 1:1124 BAKER STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305
Practice Address - Country:US
Practice Address - Phone:661-327-9376
Practice Address - Fax:661-327-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health