Healthcare Provider Details

I. General information

NPI: 1427671882
Provider Name (Legal Business Name): DHHS IHS CAO SACRED OAKS HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 COUNTY ROAD 31
DAVIS CA
95616
US

IV. Provider business mailing address

650 CAPITOL MALL RM 7100
SACRAMENTO CA
95814-4706
US

V. Phone/Fax

Practice location:
  • Phone: 916-930-3981
  • Fax:
Mailing address:
  • Phone: 916-930-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY TURNER
Title or Position: AREA EXECUTIVE OFFICER
Credential:
Phone: 916-930-3981