Healthcare Provider Details

I. General information

NPI: 1619162112
Provider Name (Legal Business Name): LAMERCIEYOUTHANDADULTSERVICES, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 09/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 FLORIN RD STE 35 4328 CARMELO OAKS COURT
SACRAMENTO CA
95822-4498
US

IV. Provider business mailing address

2251 FLORIN RD STE 35 4328 CARMELO OAKS COURT
SACRAMENTO CA
95822-4498
US

V. Phone/Fax

Practice location:
  • Phone: 916-665-2828
  • Fax:
Mailing address:
  • Phone: 916-665-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number340076AN/BN
License Number StateCA

VIII. Authorized Official

Name: MS. MARIE DANIELLE PERRY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-665-2828