Basic Information
| Provider Information | |||||||||
| NPI: | 1275947426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY STAR BEHAVIORAL HEALTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY STAR CRISIS WALK-IN CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 HUGHES WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102216336 | ||||||||
| FaxNumber: | 3102216350 | ||||||||
| Practice Location | |||||||||
| Address1: | 12240 HESPERIA RD | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923958309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602458837 | ||||||||
| FaxNumber: | 7602458854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | DUNLAP | ||||||||
| AuthorizedOfficialFirstName: | KENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CHIEF EXECUTIVE OFFIC | ||||||||
| AuthorizedOfficialTelephone: | 3102216336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.