Healthcare Provider Details

I. General information

NPI: 1154257715
Provider Name (Legal Business Name): COMMUNITY PARTNERSHIP FOR FAMILIES OF SAN JOAQUIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W ELM ST
LODI CA
95240-2117
US

IV. Provider business mailing address

PO BOX 69
LODI CA
95241-0069
US

V. Phone/Fax

Practice location:
  • Phone: 209-444-4114
  • Fax:
Mailing address:
  • Phone: 209-444-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: LYNSAY NUSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-406-3018