Healthcare Provider Details

I. General information

NPI: 1083039754
Provider Name (Legal Business Name): ANKA BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7137 AMADOR VALLEY BLVD
DUBLIN CA
94568
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 925-265-6040
  • Fax: 925-551-8924
Mailing address:
  • Phone: 925-825-4700
  • Fax: 925-825-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number019200339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN HAHN-SMITH
Title or Position: VP OF QUALITY MANAGEMENT
Credential:
Phone: 925-825-4700