Healthcare Provider Details

I. General information

NPI: 1154063907
Provider Name (Legal Business Name): ENVIRONMENTAL ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SUTTON WAY
GRASS VALLEY CA
95945-5390
US

IV. Provider business mailing address

525 SUTTON WAY
GRASS VALLEY CA
95945-5390
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-7120
  • Fax:
Mailing address:
  • Phone: 530-273-7120
  • Fax: 530-231-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MELODY KING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-283-3330