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General NPI Number Information
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NPI Number | 1861212284
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Entity Type | Organization
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Legal Business Name | BRIDGES OF HOPE CALIFORNIA
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 211 DORRIS PL
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City | STOCKTON
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State | CA
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Zip | 95204-5252
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Country | US
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Telephone | 209-990-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 211 DORRIS PL
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City | STOCKTON
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State | CA
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Zip | 95204-5252
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Country | US
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Telephone | 209-990-8733
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Fax |
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Authorized Official
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Title or Position | FOUNDER / OWNER
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Name | MS. GENEVA MOORAD
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Credential |
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Telephone | 209-990-8733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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