Organization
CONVERGENCE LIFE
Active
Other names
Convergence
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE CLONTZ (MANAGING DIRECTOR)
(503) 462-5388
Entity
Organization
Contact information
Practice address
942 CEDARCREST DR, VACAVILLE, CA 95687-7883
(503) 462-5388
Mailing address
942 CEDARCREST DR, VACAVILLE, CA 95687-7883
(503) 462-5388
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/31/2024
Last updated
10/31/2024
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