Healthcare Provider Details

I. General information

NPI: 1215962782
Provider Name (Legal Business Name): JOHN MUIR BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 GRANT ST
CONCORD CA
94520-2265
US

IV. Provider business mailing address

1400 TREAT BLVD
WALNUT CREEK CA
94597-2142
US

V. Phone/Fax

Practice location:
  • Phone: 925-674-4100
  • Fax: 925-686-1087
Mailing address:
  • Phone: 925-939-3000
  • Fax: 925-641-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number14000G418
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: CALVIN KNIGHT
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential:
Phone: 925-941-2100