Healthcare Provider Details

I. General information

NPI: 1679758148
Provider Name (Legal Business Name): PANACEA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 DIVISADERO ST SUITE 2
FRESNO CA
93721-1143
US

IV. Provider business mailing address

1617 E SAGINAW WAY SUITE 109
FRESNO CA
93704-4458
US

V. Phone/Fax

Practice location:
  • Phone: 559-241-0364
  • Fax: 559-241-0342
Mailing address:
  • Phone: 559-241-0364
  • Fax: 559-241-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN GOLDEN
Title or Position: DIRECTOR
Credential:
Phone: 559-241-0364