State Health Care Dual Diagnosis Program

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

100056BP Issued in CA

Legal business name

STATE HEALTH CARE DUAL DIAGNOSIS PROGRAM

Practice address

1145 W Hedges Ave
Suite B
Fresno, CA 93728-1219

Phone

(310) 628-9512

Fax

(818) 804-4047

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Edna Miller

Title

President

Phone

(310) 628-9512

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• State Health Care Dual Diagnosis Program Doing business as

Locations

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720299175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19300 RINALDI ST",
            "address_2": "SUITE 8270",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913261651",
            "telephone_number": "310-628-9512",
            "fax_number": "818-804-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 W HEDGES AVE",
            "address_2": "SUITE B",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937281219",
            "telephone_number": "310-628-9512",
            "fax_number": "818-804-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE HEALTH CARE DUAL DIAGNOSIS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "EDNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-628-9512",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "100056BP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMC PROVIDER NUMBER",
            "identifier": "1068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Health Care Dual Diagnosis Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gerard Staromana
• Robert Lewis Starr Jr., D.D.S.
• Stars Behavioral Health
• Start Fresh Central Valley Recovery
• State Health Care Dual Diagnosis
• Lynette Coleman Statham, LCSW
• Yannis M Stavropoulos, MD
• Staywell Medical Group
• Rmanda Steadman
• Nicholas Stearns

• Substance Use Disorder Rehabilitation Clinic/Center in Fresno, CA
• Providers in Fresno, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center 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.