Healthcare Provider Details

I. General information

NPI: 1285322701
Provider Name (Legal Business Name): THE AMELIA ANN ADAMS WHOLE LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 INGLEWOOD AVE STE K
STOCKTON CA
95207-3874
US

IV. Provider business mailing address

PO BOX 1694
STOCKTON CA
95201-1694
US

V. Phone/Fax

Practice location:
  • Phone: 209-430-2917
  • Fax:
Mailing address:
  • Phone: 209-888-7174
  • 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
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA PEOPLES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-430-2917