Healthcare Provider Details

I. General information

NPI: 1033074968
Provider Name (Legal Business Name): PEER RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N CALIFORNIA ST
STOCKTON CA
95202-1537
US

IV. Provider business mailing address

1109 N CALIFORNIA ST
STOCKTON CA
95202-1537
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-3977
  • Fax:
Mailing address:
  • Phone: 209-451-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN VICKREY
Title or Position: CHIEF FINANCIAL & OPERATING OFFICER
Credential:
Phone: 209-509-4727