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General NPI Number Information
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NPI Number | 1255419172
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Entity Type | Organization
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Legal Business Name | MEDMARK TREATMENT CENTERS - SACRAMENTO, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 7240 E SOUTHGATE DR SUITES B, E, G
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City | SACRAMENTO
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State | CA
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Zip | 95823-2627
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Country | US
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Telephone | 916-391-4293
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Fax | 916-391-4247
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Provider Business Mailing Address
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Address Line | 1720 LAKEPOINTE DR STE 117
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City | LEWISVILLE
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State | TX
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Zip | 75057-6425
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Country | US
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Telephone | 214-379-3300
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Fax | 214-379-3324
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Authorized Official
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Title or Position | VP, TREASURER
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Name | BRUCE JARVIE
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Credential |
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Telephone | 214-379-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 34-09
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License Number State | CA
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