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General NPI Number Information
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NPI Number | 1164646048
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL RESIDENTIAL TREATMENT FACILITIES
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 W HENDERSON ST
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City | EUREKA
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State | CA
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Zip | 95501-3545
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Country | US
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Telephone | 707-444-8213
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Fax | 707-444-3715
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Provider Business Mailing Address
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Address Line | PO BOX 6299
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City | EUREKA
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State | CA
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Zip | 95502-6299
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Country | US
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Telephone | 707-444-8213
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Fax | 707-444-3715
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM L DUNCAN
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Credential |
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Telephone | 707-444-8123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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