Organization
CHILDREN'S HOME OF STOCKTON
Active
Parent organization
CHILDREN'S HOME OF STOCKTON
Other names
Cypress Cottage
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S HOME OF STOCKTON
Authorized official
JOELLE GOMEZ (CEO)
(209) 466-0853
Entity
Organization
Contact information
Practice address
1236 E LINDSAY ST, STOCKTON, CA 95205-4413
(209) 466-0853
Mailing address
430 N PILGRIM ST, STOCKTON, CA 95205-4428
(209) 466-0853
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397002554
—
CA
Enumeration date
01/04/2019
Last updated
01/15/2019
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