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General NPI Number Information
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NPI Number | 1023544863
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Entity Type | Organization
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Legal Business Name | MHN GOVERNMENT SERVICES LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 344 PENDLETON WAY
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City | OAKLAND
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State | CA
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Zip | 94621-2102
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Country | US
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Telephone | 510-430-3640
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Fax | 510-430-3683
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Provider Business Mailing Address
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Address Line | 2025 AEROJET RD
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City | RANCHO CORDOVA
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State | CA
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Zip | 95742-6418
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Country | US
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Telephone | 916-353-6100
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Fax | 916-353-6809
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BILLY MAYNARD
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Credential |
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Telephone | 916-353-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 01-006-01-120
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License Number State | CA
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