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Organization
GOLDEN STATE THERAPY CENTER
Active
Organization
GOLDEN STATE THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK LYMAN RUSSELL MA, MFT (ADMINISTRATOR)
(209) 369-6996
Entity
Organization
Contact information
Practice address
1235 W VINE ST, SUITE 22, LODI, CA 95240-5109
(209) 369-6996
(209) 369-6980
Mailing address
1235 W VINE ST, SUITE 22, LODI, CA 95240-5109
(209) 369-6996
(209) 369-6980
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
CA
Other
Enumeration date
06/29/2005
Last updated
08/22/2020
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