Healthcare Provider Details

I. General information

NPI: 1457078875
Provider Name (Legal Business Name): AKASHA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 BALD MOUNTAIN RD
BROWNS VALLEY CA
95918-9591
US

IV. Provider business mailing address

PO BOX 806
BROWNS VALLEY CA
95918-0806
US

V. Phone/Fax

Practice location:
  • Phone: 530-713-1993
  • Fax:
Mailing address:
  • Phone: 530-713-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL ALY'CE WILSON
Title or Position: DIRECTOR
Credential: MAD, RADT
Phone: 530-713-1993