Healthcare Provider Details

I. General information

NPI: 1518024389
Provider Name (Legal Business Name): DRUG ABUSE ALTERNATIVES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 PROFESSIONAL DR SUITE 102
SANTA ROSA CA
95403-3007
US

IV. Provider business mailing address

2403 PROFESSIONAL DRIVE SUITE 102
SANTA ROSA CA
95403-3007
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-2233
  • Fax: 707-571-2238
Mailing address:
  • Phone: 707-571-2233
  • Fax: 707-571-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number490009RN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number490009BN
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN CHALLIS
Title or Position: CENTER POINT VICE PRESIDENT, DAAC M
Credential:
Phone: 707-571-2233