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General NPI Number Information
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NPI Number | 1275797151
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Entity Type | Organization
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Legal Business Name | DUFFY'S MYRTLEDALE, INC.
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 3076 MYRTLEDALE RD
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City | CALISTOGA
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State | CA
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Zip | 94515-1052
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Country | US
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Telephone | 707-942-6888
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Fax | 707-942-4819
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Provider Business Mailing Address
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Address Line | 3076 MYRTLEDALE RD
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City | CALISTOGA
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State | CA
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Zip | 94515-1052
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Country | US
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Telephone | 707-942-6888
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Fax | 707-942-4819
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEBBIE DUFFY
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Credential |
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Telephone | 707-942-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 280002AP
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License Number State | CA
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