Provider Demographics
NPI:1053524405
Name:COMMUNITY SERVICE ORGANIZATION BEHAVIORAL HEALTH PROGRAMS
Entity type:Organization
Organization Name:COMMUNITY SERVICE ORGANIZATION BEHAVIORAL HEALTH PROGRAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GOTAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:ED
Authorized Official - Phone:661-845-3753
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385
Mailing Address - Country:US
Mailing Address - Phone:661-845-3753
Mailing Address - Fax:661-845-4866
Practice Address - Street 1:10420 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1727
Practice Address - Country:US
Practice Address - Phone:661-845-3753
Practice Address - Fax:661-845-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health