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General NPI Number Information
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NPI Number | 1255076873
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Entity Type | Organization
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Legal Business Name | SORREL LEAF HEALING CENTER INC
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 124 INDIANOLA RD
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City | EUREKA
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State | CA
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Zip | 95503-9403
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Country | US
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Telephone | 707-267-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 124 INDIANOLA RD
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City | EUREKA
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State | CA
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Zip | 95503-9403
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Country | US
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Telephone | 707-267-7812
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Fax |
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Authorized Official
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Title or Position | PROGRAM DEVELOPMENT LEAD
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Name | ELIZABETH ANDERSON
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Credential | MSW
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Telephone | 707-267-7812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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