=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477709467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHT SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2008
-----------------------------------------------------
Last Update Date | 08/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 FLORIDA AVE SUITE 107
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-577-0217
-----------------------------------------------------
Fax | 209-577-0901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 FLORIDA AVE SUITE 107
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-577-0217
-----------------------------------------------------
Fax | 209-577-0901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. CRAIG A. ANDERSON
-----------------------------------------------------
Credential | CAS II
-----------------------------------------------------
Telephone | 209-577-0217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 500019AP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------