Basic Information
| Provider Information | |||||||||
| NPI: | 1447740063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL STAR BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 HUGHES WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102216336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3433 W SHAW AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937113229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596002382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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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 | Y | Agencies | Community/Behavioral Health |
No ID Information.