Healthcare Provider Details

I. General information

NPI: 1376815282
Provider Name (Legal Business Name): HEALTHY CONNECTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 W VINE ST SUITE 20
LODI CA
95240-5144
US

IV. Provider business mailing address

1947 N CALIFORNIA ST STE C
STOCKTON CA
95204-6029
US

V. Phone/Fax

Practice location:
  • Phone: 209-339-7410
  • Fax: 209-339-8778
Mailing address:
  • Phone: 209-463-0870
  • Fax: 209-463-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNEST JOSEPH VASTI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 209-463-0870