Healthcare Provider Details

I. General information

NPI: 1225581382
Provider Name (Legal Business Name): COMPREHENSIVE ADDICTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 E DINUBA AVE
SELMA CA
93662-9405
US

IV. Provider business mailing address

9080 E DINUBA AVE
SELMA CA
93662-9405
US

V. Phone/Fax

Practice location:
  • Phone: 559-477-3399
  • Fax:
Mailing address:
  • Phone: 559-477-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number101YA04000X
License Number StateCA

VIII. Authorized Official

Name: ROLAND DAVID KING
Title or Position: COUNSELOR 1
Credential:
Phone: 559-264-5096