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General NPI Number Information
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NPI Number | 1427671882
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Entity Type | Organization
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Legal Business Name | DHHS IHS CAO SACRED OAKS HEALING CENTER
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 33100 COUNTY ROAD 31
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City | DAVIS
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State | CA
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Zip | 95616
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Country | US
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Telephone | 916-930-3981
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Fax |
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Provider Business Mailing Address
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Address Line | 650 CAPITOL MALL RM 7100
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City | SACRAMENTO
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State | CA
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Zip | 95814-4706
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Country | US
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Telephone | 916-930-3981
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Fax |
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Authorized Official
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Title or Position | AREA EXECUTIVE OFFICER
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Name | JEFFREY TURNER
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Credential |
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Telephone | 916-930-3981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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