Healthcare Provider Details

I. General information

NPI: 1528318318
Provider Name (Legal Business Name): DALE WARD CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 3RD ST
EUREKA CA
95501-0711
US

IV. Provider business mailing address

670 9TH ST SUITE 203
ARCATA CA
95521-6248
US

V. Phone/Fax

Practice location:
  • Phone: 707-407-8311
  • Fax: 707-445-4499
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA6860911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: