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General NPI Number Information
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NPI Number | 1679706444
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Entity Type | Organization
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Legal Business Name | FATHER KEITH B. KENNEY ELEMENTARY SCHOOL
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 3307 BROADWAY STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95817-2821
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Country | US
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Telephone | 916-454-4242
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Fax | 916-454-2930
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Provider Business Mailing Address
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Address Line | 3307 BROADWAY STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95817-2821
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Country | US
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Telephone | 916-454-4242
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Fax | 916-454-2930
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SANDRA HILL
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Credential | AA
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Telephone | 916-454-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 340008AN
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License Number State | CA
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