Healthcare Provider Details

I. General information

NPI: 1205970266
Provider Name (Legal Business Name): ZONA SECA YOUTH AND FAMILY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NORTH I ST
LOMPOC CA
93436
US

IV. Provider business mailing address

3486 MESA CIRCLE DRIVE 211
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-740-9799
  • Fax: 805-740-2799
Mailing address:
  • Phone: 805-733-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number014619
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WILLIAM EDWARD ELDREDGE
Title or Position: EVENING PROGRAM MANAGER
Credential: BASW,RAS,NCAC 1
Phone: 805-740-9799