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General NPI Number Information
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NPI Number | 1437657301
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Entity Type | Organization
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Legal Business Name | MENDING HEARTS MENDING MINDS INC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 6524 44TH STREET
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City | SACRAMENTO
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State | CA
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Zip | 95823-5667
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Country | US
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Telephone | 916-960-7795
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 W EL CAMINO AVENUE #464
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City | SACRAMENTO
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State | CA
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Zip | 95833-9756
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Country | US
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Telephone | 916-960-7795
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | GREGORY DWAYNE MORRISON
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Credential | M.S.
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Telephone | 916-960-7795
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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 | IMF83840
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License Number State | CA
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