Healthcare Provider Details

I. General information

NPI: 1346294907
Provider Name (Legal Business Name): NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDANCE, SACRAMENTO REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 BELL EXECUTIVE LN
SACRAMENTO CA
95825-4068
US

IV. Provider business mailing address

2316 BELL EXECUTIVE LN
SACRAMENTO CA
95825-4067
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-9217
  • Fax: 916-576-6274
Mailing address:
  • Phone: 916-922-9217
  • Fax: 916-576-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number19608
License Number StateCA

VIII. Authorized Official

Name: NIKKI BUCKSTEAD PANE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-922-9217