Healthcare Provider Details

I. General information

NPI: 1013720457
Provider Name (Legal Business Name): DOWNTOWN STREETS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 H ST STE 100
MODESTO CA
95354-2400
US

IV. Provider business mailing address

1671 THE ALAMEDA STE 301
SAN JOSE CA
95126-2222
US

V. Phone/Fax

Practice location:
  • Phone: 408-899-7350
  • Fax:
Mailing address:
  • Phone: 408-899-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARINA PETERSON
Title or Position: CHIEF FINANCIAL & ADMIN OFFICER
Credential:
Phone: 669-224-2762