Provider Demographics
NPI:1912122250
Name:SERVICE FIRST OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:SERVICE FIRST OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:SUDCC II
Authorized Official - Phone:209-762-3014
Mailing Address - Street 1:102 W BIANCHI RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-7132
Mailing Address - Country:US
Mailing Address - Phone:209-644-6320
Mailing Address - Fax:209-644-6336
Practice Address - Street 1:SERVICE FIRST OF NORTHERN CALIFORNIA
Practice Address - Street 2:3422 WEST. HAMMER LANE SUITE A,B,C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:209-888-5088
Practice Address - Fax:209-451-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390017AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty