Healthcare Provider Details

I. General information

NPI: 1275947426
Provider Name (Legal Business Name): VALLEY STAR BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12240 HESPERIA RD
VICTORVILLE CA
92395-8309
US

IV. Provider business mailing address

1501 HUGHES WAY SUITE 150
LONG BEACH CA
90810-1878
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-8837
  • Fax: 760-245-8854
Mailing address:
  • Phone: 310-221-6336
  • Fax: 310-221-6350

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: KENT DUNLAP
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential:
Phone: 310-221-6336