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General NPI Number Information
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NPI Number | 1053809830
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Entity Type | Organization
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Legal Business Name | CENTRAL STAR BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 401 S ST STE 101
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City | SACRAMENTO
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State | CA
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Zip | 95811-6919
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Country | US
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Telephone | 510-635-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 7677 OAKPORT ST STE 1010
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City | OAKLAND
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State | CA
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Zip | 94621-1943
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Country | US
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Telephone | 510-635-9705
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF EXECUTIVE OFFIC
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Name | KENT DUNLAP
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Credential |
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Telephone | 310-221-6336
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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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