NPIMap

Organization Active NPI

Children'S Home of Stockton

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Stockton, CA
National Provider Identifier
1831662683
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
CHILDREN'S HOME OF STOCKTON
Practice address
1236 E Lindsay St
Stockton, CA 95205-4413
Phone
(209) 466-0853
NPI assigned
Jan 4, 2019
Organization subpart
Yes
Parent organization
CHILDREN'S HOME OF STOCKTONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Authorized official

Name
Joelle Gomez
Title
Ceo
Phone
(209) 466-0853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

1236 E Lindsay St
Stockton, CA 95205-4413

Mailing address

430 N Pilgrim St
Stockton, CA 95205-4428
Phone (209) 466-0853

Other identifiers 1

IdentifierTypeStateIssuer
397002554MedicaidCA

Other names 1

  • Cypress Cottage Other name

National Provider Directory

National Provider Directory
Tax ID family
Children'S Home of Stockton6 organizations share this tax ID, including this one
Part of
Children'S Home of Stockton

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1236 E Lindsay St
Stockton, CA 95205
Phone (209) 466-0853

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1831662683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 N PILGRIM ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952054428",
            "telephone_number": "209-466-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 E LINDSAY ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952054413",
            "telephone_number": "209-466-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOME OF STOCKTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HOME OF STOCKTON",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "JOELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-466-0853"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "397002554",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cypress Cottage",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Cypress Cottage",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; 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.