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General NPI Number Information
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NPI Number | 1578976080
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Entity Type | Organization
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Legal Business Name | MEDMARK TREATMENT SERVICES
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 7240 E. SOUTHGATE DRIVE
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City | SACRAMENTO
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State | CA
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Zip | 95823
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Country | US
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Telephone | 916-391-4293
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Fax |
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Provider Business Mailing Address
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Address Line | 7240 E. SOUTHGATE DRIVE
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City | SACRAMENTO
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State | CA
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Zip | 95823
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Country | US
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Telephone |
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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 | KRISTEN HANSON
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Credential |
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Telephone | 916-391-4294
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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 |
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License Number State | CA
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