Healthcare Provider Details

I. General information

NPI: 1124550850
Provider Name (Legal Business Name): ACTION FAMILY COUNSELING BAKERSFIELD RTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26393 BOUQUET CANYON RD # C-134
SANTA CLARITA CA
91350
US

IV. Provider business mailing address

407 HELEN WAY
BAKERSFIELD CA
93307-6112
US

V. Phone/Fax

Practice location:
  • Phone: 800-367-8336
  • Fax: 661-297-9701
Mailing address:
  • Phone: 800-367-8336
  • Fax: 661-297-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number150062BD
License Number StateCA

VIII. Authorized Official

Name: MR. CARY QUASHEN
Title or Position: CEO
Credential:
Phone: 800-367-8336