Provider Demographics
NPI:1841313558
Name:SAN BENITO COUNTY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SAN BENITO COUNTY BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QUALITY IMPROVEMENT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:831-636-4020
Mailing Address - Street 1:1131 SAN FELIPE ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2800
Mailing Address - Country:US
Mailing Address - Phone:831-636-4020
Mailing Address - Fax:831-636-4025
Practice Address - Street 1:544 SAN BENITO ST
Practice Address - Street 2:STE. 102
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3832
Practice Address - Country:US
Practice Address - Phone:831-636-4020
Practice Address - Fax:831-636-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center