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General NPI Number Information
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NPI Number | 1831456516
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Entity Type | Organization
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Legal Business Name | STRATEGIE FOR CHANGE
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 4343 WILLIAMSBOURGH DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-2006
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Country | US
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Telephone | 916-395-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 4343 WILLIAMSBOURGH DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-2006
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Country | US
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Telephone | 916-395-3552
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MISS BETTY MCORNELIUS
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Credential | D.O
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Telephone | 916-395-3552
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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 | RW4528
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License Number State | CA
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