Individual provider Active NPI

Cassandra Sysouvanh

  • Day Training/Habilitation Specialist
  • Stockton, CA
National Provider Identifier
1902458508
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Day Training/Habilitation SpecialistTaxonomy code 373H00000X
Practice address
4545 Georgetown PL
Stockton, CA 95207-6215
Phone
(209) 639-4685
NPI assigned
Jul 12, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X
Case Manager/Care Coordinator 171M00000X
Day Training/Habilitation Specialist 373H00000X CA Primary

Addresses

Primary practice location

4545 Georgetown PL
Stockton, CA 95207-6215

Mailing address

PO Box 135
Stockton, CA 95201-0135
Phone (209) 662-3099

Other practice location 1

7224 S Recovery Rd
French Camp, CA 95231-8901
Phone (209) 888-6595

Other practice location 2

7236 S Recovery Rd
French Camp, CA 95231-8901
Phone (209) 888-6595

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Csysouvanh@telecarecorp.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Turning Point Community Programs PastSince Aug 1, 2023 Accepting new patients
Turning Point Community Programs PastSince Sep 1, 2023 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1902458508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 135",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952010135",
            "telephone_number": "209-662-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 GEORGETOWN PL",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076215",
            "telephone_number": "209-639-4685"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7224 S Recovery Rd",
            "address_purpose": "LOCATION",
            "city": "French Camp",
            "state": "CA",
            "postal_code": "952318901",
            "country_code": "US",
            "telephone_number": "209-888-6595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7236 S Recovery Rd",
            "address_purpose": "LOCATION",
            "city": "French Camp",
            "state": "CA",
            "postal_code": "952318901",
            "country_code": "US",
            "telephone_number": "209-888-6595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SYSOUVANH",
        "first_name": "CASSANDRA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-12",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Csysouvanh@telecarecorp.com",
            "affiliation": "N",
            "address_1": "4545 Georgetown Pl",
            "city": "Stockton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "952076215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Apr 8, 2025; 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.