=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154548535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUCCESSFUL ALTERNATIVES FOR ADDICTION AND COUNSELING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1628 BROADWAY STREET
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-649-8300
-----------------------------------------------------
Fax | 707-649-8302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 LAKEPOINTE DR STE 117
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75057-6425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-379-3300
-----------------------------------------------------
Fax | 214-853-9018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, TREASURER
-----------------------------------------------------
Name | BRUCE JARVIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-379-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 48-02
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2800X
-----------------------------------------------------
Taxonomy Name | Methadone Clinic
-----------------------------------------------------
License Number | 48-04
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------