Healthcare Provider Details

I. General information

NPI: 1558698928
Provider Name (Legal Business Name): AUGUST WEST FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 GOLF CIR
ROYAL OAKS CA
95076-5465
US

IV. Provider business mailing address

PO BOX 669
CAPITOLA CA
95010-0669
US

V. Phone/Fax

Practice location:
  • Phone: 831-786-8991
  • Fax: 831-786-8991
Mailing address:
  • Phone: 831-786-8991
  • Fax: 831-786-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA8512805
License Number StateCA

VIII. Authorized Official

Name: RICHARD MICHAEL HARRISON
Title or Position: CLINICAL DIRECTOR
Credential: CADC II; ICADC
Phone: 831-786-8991