Provider Demographics
NPI:1942584354
Name:SAN JOAQUIN
Entity Type:Organization
Organization Name:SAN JOAQUIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PSYCHIATRIC TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:SPT
Authorized Official - Phone:209-468-5129
Mailing Address - Street 1:7000 MICHAEL CANLIS WAY
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9781
Mailing Address - Country:US
Mailing Address - Phone:209-468-5129
Mailing Address - Fax:209-468-5184
Practice Address - Street 1:7000 MICHAEL CANLIS WAY
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9781
Practice Address - Country:US
Practice Address - Phone:209-468-5129
Practice Address - Fax:209-468-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30322310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness