NPIMap

Organization Active NPI

University of the Pacific

Doing business as Community Re-Entry Program, ILS

  • Community/Behavioral Health Agency
  • Stockton, CA
National Provider Identifier
1851414189
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
UNIVERSITY OF THE PACIFIC
Doing business as
Community Re-Entry Program, ILS
Practice address
405 E Pine St
Stockton, CA 95204-5522
Phone
(209) 946-2132
Fax
(209) 946-2284
NPI assigned
Apr 10, 2007
Last updated
Jun 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Authorized official

Name
Holly WhiteNPI 1053432781
Title
Executive Director
Phone
(209) 946-2132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

405 E Pine St
Stockton, CA 95204-5522

Mailing address

3601 Pacific Ave
Stockton, CA 95211
Phone (209) 946-2132

Other identifiers 2

IdentifierTypeStateIssuer
90441OtherCAMEDI-CAL
90432OtherCAMEDI-CAL

Other names 1

  • Community Re-Entry Program, ILS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
University of the Pacif29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

3601 Pacific Ave
Univ of the Pacific, CA 95211
Phone (209) 946-2132

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1851414189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 PACIFIC AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95211",
            "telephone_number": "209-946-2132",
            "fax_number": "209-946-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E PINE ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045522",
            "telephone_number": "209-946-2132",
            "fax_number": "209-946-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF THE PACIFIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-946-2132"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "90441",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "90432",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Re-Entry Program, ILS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 23, 2016; 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.