Healthcare Provider Details

I. General information

NPI: 1982739538
Provider Name (Legal Business Name): COUNCIL ON ALCOHOLISM AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 VALLEY RD
OAK VIEW CA
93022-9416
US

IV. Provider business mailing address

41 VALLEY RD
OAK VIEW CA
93022-9416
US

V. Phone/Fax

Practice location:
  • Phone: 805-649-9159
  • Fax:
Mailing address:
  • Phone: 805-649-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number420022EN
License Number StateCA

VIII. Authorized Official

Name: PENNY JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-963-1433