Healthcare Provider Details

I. General information

NPI: 1629856430
Provider Name (Legal Business Name): DRUG ABUSE ALTERNATIVES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

IV. Provider business mailing address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3295
  • Fax: 707-544-9011
Mailing address:
  • Phone: 707-544-3295
  • Fax: 707-544-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ADAY
Title or Position: OUTPATIENT MANAGER
Credential:
Phone: 707-544-3295