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General NPI Number Information
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NPI Number | 1386452175
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Entity Type | Organization
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Legal Business Name | FAMILY PROMISE OF SAN JOAQUIN COUNTY
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Dates
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Enumeration Date | 12/25/2024
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Last Update Date | 12/25/2024
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Provider Practice Location Address
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Address Line | 6148 GETTYSBURG PL
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City | STOCKTON
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State | CA
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Zip | 95207-4249
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Country | US
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Telephone | 209-323-4384
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Fax |
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Provider Business Mailing Address
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Address Line | 6148 GETTYSBURG PL
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City | STOCKTON
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State | CA
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Zip | 95207-4249
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JORY GWASDOFF
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Credential |
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Telephone | 209-986-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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