Provider Demographics
NPI:1922250158
Name:BHRS
Entity Type:Organization
Organization Name:BHRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW INTERN
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:559-443-9220
Mailing Address - Street 1:1904 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-7507
Mailing Address - Country:US
Mailing Address - Phone:209-541-2077
Mailing Address - Fax:
Practice Address - Street 1:1550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366
Practice Address - Country:US
Practice Address - Phone:209-341-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health