Basic Information
| Provider Information | |||||||||
| NPI: | 1851637151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY STAR BEHAVIORAL HEALTH, INC. | ||||||||
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| OtherOrganizationName: | VALLEY STAR CRT - 'THE STAY' | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 HUGHES WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102216336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 780 E GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924151003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097634760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2012 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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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 | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 2016029 | 01 | CA | DEPARTMENT OF MENTAL HEALTH | OTHER |