MEDICARE: PANACEA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477730968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEA, INC.

Provider Business Mailing Address
First Line	:	3353 BRADSHAW RD
Second Line	:	SUITE 106
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BROADWAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-3301
Country	:	US
Telephone Number	:	916-854-4564
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. TRISHA SEASTROM
Credential	:	BA, CADCA, CAMF
Telephone Number	:	916-854-4564

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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Directions to “PANACEA, INC. ” Practice Location

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