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General NPI Number Information
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NPI Number | 1669976619
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Entity Type | Organization
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Legal Business Name | ILEIHNO BOPACHEMIHN, INC.
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 2312 PAMELA LANE
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City | SACRAMENTO
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State | CA
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Zip | 95825
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Country | US
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Telephone | 916-692-8172
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Fax | 916-692-8178
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Provider Business Mailing Address
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Address Line | 4343 MARCONI AVENUE SUITE 6
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City | SACRAMENTO
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State | CA
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Zip | 95821-4343
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Country | US
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Telephone | 916-571-5060
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Fax | 855-447-2658
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY KAY CURTIS
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Credential |
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Telephone | 916-296-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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