Healthcare Provider Details

I. General information

NPI: 1063700656
Provider Name (Legal Business Name): ANKA BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2011
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILLMONT AVENUE
VENTURA CA
93003
US

IV. Provider business mailing address

1850 GATEWAY BLVD SUITE 900
CONCORD CA
94520-8414
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-7750
  • Fax: 805-653-5974
Mailing address:
  • Phone: 925-825-4700
  • Fax: 805-653-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberD05511203
License Number StateAZ

VIII. Authorized Official

Name: GINA M VYROSTEK
Title or Position: SENIOR QM MANAGER
Credential:
Phone: 925-825-4700