Provider Demographics
NPI:1528335791
Name:STOCKTON CIRCLE OF FRIENDS ADULT PROGRAMS
Entity type:Organization
Organization Name:STOCKTON CIRCLE OF FRIENDS ADULT PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIBA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-684-6542
Mailing Address - Street 1:3120 E ANITA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-3905
Mailing Address - Country:US
Mailing Address - Phone:209-451-0315
Mailing Address - Fax:209-451-0602
Practice Address - Street 1:3128 E ANITA STREET
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205
Practice Address - Country:US
Practice Address - Phone:209-451-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility