| Community Re-entry Program, Ils | |
|
405 E Pine St Stockton CA 95204-5522 | |
| (209) 946-2132 | |
| (209) 946-2284 |
| Full Name | Community Re-entry Program, Ils |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 405 E Pine St, Stockton, California |
| Authorized Official Name and Position | Holly White (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2099462132 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Re-entry Program, Ils 3601 Pacific Ave Stockton CA 95211 Ph: (209) 946-2132 | Community Re-entry Program, Ils 405 E Pine St Stockton CA 95204-5522 Ph: (209) 946-2132 |
| NPI Number | 1851414189 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 06/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851414189 | NPI | - | NPPES |
| 90441 | Other | CA | MEDI-CAL |
| 90432 | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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