Healthcare Provider Details

I. General information

NPI: 1164646048
Provider Name (Legal Business Name): TRANSITIONAL RESIDENTIAL TREATMENT FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W HENDERSON ST
EUREKA CA
95501-3545
US

IV. Provider business mailing address

PO BOX 6299
EUREKA CA
95502-6299
US

V. Phone/Fax

Practice location:
  • Phone: 707-444-8213
  • Fax: 707-444-3715
Mailing address:
  • Phone: 707-444-8213
  • Fax: 707-444-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. WILLIAM L DUNCAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-444-8123