Healthcare Provider Details

I. General information

NPI: 1295490365
Provider Name (Legal Business Name): CENTRAL VALLEY LOW INCOME HOUSING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 W MARCH LN STE 350
STOCKTON CA
95207-8218
US

IV. Provider business mailing address

PO BOX 4732
STOCKTON CA
95204-0732
US

V. Phone/Fax

Practice location:
  • Phone: 209-472-7200
  • Fax: 209-954-9548
Mailing address:
  • Phone: 209-472-7200
  • Fax: 209-954-9548

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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN MENDELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-472-7200