Healthcare Provider Details

I. General information

NPI: 1447543905
Provider Name (Legal Business Name): JUST 4KIDZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N STANISLAUS ST
STOCKTON CA
95202-2646
US

IV. Provider business mailing address

605 W HERNDON AVE STE 800
CLOVIS CA
93612-0193
US

V. Phone/Fax

Practice location:
  • Phone: 559-389-3963
  • Fax:
Mailing address:
  • Phone: 559-389-3963
  • Fax:

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: EUGENE ALTON TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 559-389-3963