=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497397665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVIRONMENTAL ALTERNATIVES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1229 BROADWAY
-----------------------------------------------------
City | RICHVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-882-4125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3940
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95971-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 530-231-0265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MELODY KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-283-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------