Healthcare Provider Details

I. General information

NPI: 1346736196
Provider Name (Legal Business Name): ANKA BEHAVIORAL HEALTH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 PARKS LN
CARMICHAEL CA
95608-3844
US

IV. Provider business mailing address

3480 BUSKIRK AVE STE 300
PLEASANT HILL CA
94523-4343
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-2424
  • Fax: 916-990-9478
Mailing address:
  • Phone: 925-825-4700
  • Fax: 925-429-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: GINA VYROSTEK
Title or Position: VP UM/COMPLIANCE
Credential:
Phone: 925-825-4700