Provider Demographics
NPI:1215962782
Name:JOHN MUIR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:JOHN MUIR BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-941-2100
Mailing Address - Street 1:1400 TREAT BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2142
Mailing Address - Country:US
Mailing Address - Phone:925-939-3000
Mailing Address - Fax:925-641-2236
Practice Address - Street 1:2740 GRANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2265
Practice Address - Country:US
Practice Address - Phone:925-674-4100
Practice Address - Fax:925-686-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14000G418283Q00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR34131FMedicaid
CA061860OtherVALUE OPTIONS
CA054131OtherBX OF CALIFORNIA
CAHSM34131FMedicaid
CAZZZH0700ZOtherBLUE SHIELD OF CALIF
CAZZZ15697ZMedicare ID - Type UnspecifiedPART B/OUTPATIENT SERVICE
CAHSM34131FMedicaid