Provider Demographics
NPI:1396944336
Name:EL CONCILIO CALIFORNIA
Entity type:Organization
Organization Name:EL CONCILIO CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF STRATEGIC INNOVATION
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:APOSTOLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-337-7515
Mailing Address - Street 1:445 N SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2003
Mailing Address - Country:US
Mailing Address - Phone:209-444-8915
Mailing Address - Fax:209-444-8905
Practice Address - Street 1:237 E CHANNEL ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2003
Practice Address - Country:US
Practice Address - Phone:209-444-8915
Practice Address - Fax:209-444-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
CALCS56811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty