Healthcare Provider Details

I. General information

NPI: 1144055302
Provider Name (Legal Business Name): AH ADDICTION CARE OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAPITOL MALL STE 2350
SACRAMENTO CA
95814-4737
US

IV. Provider business mailing address

303 TWIN DOLPHIN DR STE 600-6002
REDWOOD CITY CA
94065-1497
US

V. Phone/Fax

Practice location:
  • Phone: 844-542-5481
  • Fax: 877-237-0105
Mailing address:
  • Phone: 844-542-5481
  • Fax: 877-237-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID CRISTMAN
Title or Position: COO
Credential:
Phone: 415-385-1902