Golden State Therapy Center

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

GOLDEN STATE THERAPY CENTER

Practice address

1235 W Vine St
Suite 22
Lodi, CA 95240-5109

Phone

(209) 369-6996

Fax

(209) 369-6980

NPI assigned

Jun 29, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Frank Lyman Russell, MA, MFT

Title

Administrator

Phone

(209) 369-6996

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theodore Avram Goodman, MD

  • Psychiatry Physician
  • Sacramento, CA
  • NPI 1841386471
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720085343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 W VINE ST",
            "address_2": "SUITE 22",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-369-6996",
            "fax_number": "209-369-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W VINE ST",
            "address_2": "SUITE 22",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-369-6996",
            "fax_number": "209-369-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "LYMAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-369-6996",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MFT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronna Malekia Glover I
• Marisa M Godi, M.S., CCC-SLP
• Gods Love Outreach Ministries
• Gods Love Outreach Ministries
• Gods Love Outreach Ministries
• Marshall E. Gomes, D.D.S.
• Nicolas Arthur Gomez
• Amanda Gonzales, PTA
• Esperanza Gonzales
• Carina Fabiana Gonzalez, M.D.

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Lodi, CA
• Providers in Lodi, CA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.