MEDICARE: VALLEY STAR BEHAVIORAL HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204511	OTHER	CA	CITY OF S.B. BIZ LIC.
2	36CL	OTHER	CA	SAN BERNARDINO CTY PROV #
3	2403428	OTHER	CA	STATE CORP. #

General Provider Information

NPI Number	:	1033269543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY STAR BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	1585 SOUTH D STREET
Second Line	:	SUITE 101, 205
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3257
Country	:	US
Telephone Number	:	909-388-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 SOUTH D STREET
Second Line	:	SUITE 101, 205
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3257
Country	:	US
Telephone Number	:	909-388-2222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF EXECUTIVE OFFIC
Name	:	KENT DUNLAP
Credential	:
Telephone Number	:	310-221-6336

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	02/08/2017

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