Provider Demographics
NPI:1447662507
Name:STOCKTON CONGREGATIONAL HOMES
Entity type:Organization
Organization Name:STOCKTON CONGREGATIONAL HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5101
Mailing Address - Street 1:1319 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1001
Mailing Address - Country:US
Mailing Address - Phone:209-466-4341
Mailing Address - Fax:209-466-8853
Practice Address - Street 1:1319 N MADISON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1001
Practice Address - Country:US
Practice Address - Phone:209-466-4341
Practice Address - Fax:209-466-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390300536310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility