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Organization
UNIVERSITY OF THE PACIFIC
Active
Organization
UNIVERSITY OF THE PACIFIC
Active
Other names
Community Re-Entry Program, ILS
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY WHITE (EXECUTIVE DIRECTOR)
(209) 946-2132
Entity
Organization
Contact information
Practice address
405 E PINE ST, STOCKTON, CA 95204-5522
(209) 946-2132
(209) 946-2284
Mailing address
3601 PACIFIC AVE, STOCKTON, CA 95211
(209) 946-2132
(209) 946-2284
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90432
MEDI-CAL
CA
01
—
90441
MEDI-CAL
CA
Enumeration date
04/10/2007
Last updated
06/23/2016
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