Healthcare Provider Details

I. General information

NPI: 1710101084
Provider Name (Legal Business Name): ANKA BEHAVIORAL HEALTH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 S BRIGHT RD
FRENCH CAMP CA
95231
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 209-982-1235
  • Fax:
Mailing address:
  • Phone: 925-825-4700
  • Fax: 925-825-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number397001381
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number397001381
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number397001381
License Number StateCA

VIII. Authorized Official

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