Healthcare Provider Details

I. General information

NPI: 1588706790
Provider Name (Legal Business Name): NEW DIRECTIONS ADOLESCENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 STONY POINT RD
SANTA ROSA CA
95407-8080
US

IV. Provider business mailing address

PO BOX 1819
ROHNERT PARK CA
94927-1819
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-3700
  • Fax:
Mailing address:
  • Phone: 707-585-3700
  • Fax: 707-585-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN POWERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-585-3700