Provider Demographics
NPI:1144359282
Name:MOSS BEACH HOMES - ABH
Entity type:Organization
Organization Name:MOSS BEACH HOMES - ABH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-866-4080
Mailing Address - Street 1:440 E CANAL DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3936
Mailing Address - Country:US
Mailing Address - Phone:209-668-6121
Mailing Address - Fax:209-669-2588
Practice Address - Street 1:440 E CANAL DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3936
Practice Address - Country:US
Practice Address - Phone:209-668-6121
Practice Address - Fax:209-669-2588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSS BEACH HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health