Healthcare Provider Details

I. General information

NPI: 1689563389
Provider Name (Legal Business Name): PEACEMAKERS LOVE FOUNDATION GOOD CAUSE SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 SUNRISE BLVD STE A
CITRUS HEIGHTS CA
95610-1603
US

IV. Provider business mailing address

8016 SUNRISE BLVD STE A
CITRUS HEIGHTS CA
95610-1603
US

V. Phone/Fax

Practice location:
  • Phone: 916-969-0260
  • Fax: 916-993-8580
Mailing address:
  • Phone: 916-969-0260
  • Fax: 916-993-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MALCOLM A JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-969-0260