NPIMap

Organization Active NPI

San Joaquin

  • Mental Illness Intermediate Care Facility
  • French Camp, CA
National Provider Identifier
1942584354
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
PT30322 Issued in CA
Legal business name
SAN JOAQUIN
Practice address
7000 Michael Canlis Way
French Camp, CA 95231-9781
Phone
(209) 468-5129
Fax
(209) 468-5184
NPI assigned
Oct 4, 2011
Last updated
Oct 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Authorized official

Name
Belinda Graham, SPT
Title
Senior Psychiatric Technician
Phone
(209) 468-5129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X PT30322 CA Primary

Addresses

Primary practice location

7000 Michael Canlis Way
French Camp, CA 95231-9781

Mailing address

7000 Michael Canlis Way
French Camp, CA 95231-9781
Phone (209) 468-5129

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317686400000",
    "number": "1942584354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 MICHAEL CANLIS WAY",
            "city": "FRENCH CAMP",
            "state": "CA",
            "postal_code": "952319781",
            "telephone_number": "209-468-5129",
            "fax_number": "209-468-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 MICHAEL CANLIS WAY",
            "city": "FRENCH CAMP",
            "state": "CA",
            "postal_code": "952319781",
            "telephone_number": "209-468-5129",
            "fax_number": "209-468-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-04",
        "last_updated": "2011-10-04",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "SENIOR PSYCHIATRIC TECHNICIAN",
        "authorized_official_telephone_number": "209-468-5129",
        "authorized_official_credential": "SPT"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "CA",
            "license": "PT30322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in French Camp, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.