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General NPI Number Information
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NPI Number | 1053524405
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Entity Type | Organization
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Legal Business Name | COMMUNITY SERVICE ORGANIZATION BEHAVIORAL HEALTH PROGRAMS
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 10420 MAIN ST
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City | LAMONT
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State | CA
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Zip | 93241-1727
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Country | US
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Telephone | 661-845-3753
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Fax | 661-845-4866
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Provider Business Mailing Address
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Address Line | PO BOX 3067
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City | BAKERSFIELD
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State | CA
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Zip | 93385
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Country | US
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Telephone | 661-845-3753
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Fax | 661-845-4866
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DWAYNE ANTHONY GOTAY SR.
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Credential | E.D.
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Telephone | 661-845-3753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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