Healthcare Provider Details

I. General information

NPI: 1447737333
Provider Name (Legal Business Name): ELK GROVE REHAB & COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 LAGUNA BLVD., SUITE 480
ELK GROVE CA
95758
US

IV. Provider business mailing address

7807 LAGUNA BLVD STE 480
ELK GROVE CA
95758-7953
US

V. Phone/Fax

Practice location:
  • Phone: 916-385-4438
  • Fax: 916-897-4438
Mailing address:
  • Phone: 916-385-4438
  • Fax: 916-897-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK JAY AUSTIN
Title or Position: CEO/PA
Credential: PA
Phone: 916-385-4438