Healthcare Provider Details

I. General information

NPI: 1942112438
Provider Name (Legal Business Name): STOCKTON DETOX CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 WHALERS WAY
STOCKTON CA
95219-8810
US

IV. Provider business mailing address

6906 WHALERS WAY
STOCKTON CA
95219-8810
US

V. Phone/Fax

Practice location:
  • Phone: 209-612-7092
  • Fax:
Mailing address:
  • Phone: 209-612-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. REGGIE WESTMORELANDS
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-612-7092