Healthcare Provider Details

I. General information

NPI: 1144359282
Provider Name (Legal Business Name): MOSS BEACH HOMES - ABH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E CANAL DR
TURLOCK CA
95380-3936
US

IV. Provider business mailing address

440 E CANAL DR
TURLOCK CA
95380-3936
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-6121
  • Fax: 209-669-2588
Mailing address:
  • Phone: 209-668-6121
  • Fax: 209-669-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. VERNON BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 650-866-4080