Healthcare Provider Details

I. General information

NPI: 1548549561
Provider Name (Legal Business Name): ANKA BEHAVIORAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-7750
  • Fax:
Mailing address:
  • Phone: 805-233-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number6700
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES KAIRYS
Title or Position: DIRECTOR
Credential: P.H.D.
Phone: 805-233-7749