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General NPI Number Information
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NPI Number | 1821774035
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Entity Type | Organization
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Legal Business Name | VDR ENTERPRISE
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 7489 24TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95822-5319
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Country | US
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Telephone | 916-470-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 9075 ELK GROVE BLVD STE 130
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City | ELK GROVE
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State | CA
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Zip | 95624-2071
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Country | US
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Telephone | 916-470-4100
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE SUPPORT ANALYST
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Name | VALERIE WILLIAMS
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Credential |
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Telephone | 916-470-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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