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General NPI Number Information
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NPI Number | 1457785222
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Entity Type | Organization
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Legal Business Name | PACIFIC HARBOR TREATMENT, INC.
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 3485 BERETANIA WAY
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City | SACRAMENTO
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State | CA
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Zip | 95834-2548
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Country | US
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Telephone | 916-285-0885
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Fax | 916-285-0885
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Provider Business Mailing Address
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Address Line | 3485 BERETANIA WAY
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City | SACRAMENTO
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State | CA
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Zip | 95834-2548
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Country | US
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Telephone | 916-285-0885
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Fax | 916-285-0885
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SUNNY J LANGLEY
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Credential | CAS
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Telephone | 916-285-0885
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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 | 340104AP
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License Number State | CA
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