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General NPI Number Information
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NPI Number | 1467739003
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Entity Type | Organization
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Legal Business Name | ALCOHOL DRUG CARE SERVICES,INC.
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 528 5TH ST
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City | EUREKA
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State | CA
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Zip | 95501-1033
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Country | US
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Telephone | 707-445-1391
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Fax | 707-445-2599
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Provider Business Mailing Address
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Address Line | 528 5TH ST
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City | EUREKA
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State | CA
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Zip | 95501-1033
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Country | US
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Telephone | 707-445-1391
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Fax | 707-445-2599
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SCOTT JACK CUNNINGHAM
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Credential | CAS
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Telephone | 707-445-1391
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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 | 120009CN
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 120009AN
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License Number State | CA
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